鼻咽癌放疗后颅底坏死的治疗策略及影响因素探讨

Exploration of treatment strategies and influencing factors for skull base osteoradionecrosis in nasopharyngeal carcinoma

摘要:

目的 通过回顾性分析鼻咽癌放疗后颅底坏死病例，探讨其治疗策略以及相关因素对预后的影响。方法 收集2018年6月—2024年6月于广西壮族自治区人民医院耳鼻咽喉头颈科就诊，具备完整随访影像资料的60例鼻咽癌放疗后颅底坏死患者的临床资料，其中非手术治疗组21例，手术治疗组39例。采用二分类Logistic回归分析多种因素对预后的影响，采用Mann-Whitney U检验分析手术干预对创面愈合及头痛症状的改善情况。结果 二分类Logistic回归分析显示，放射性鼻咽颅底骨坏死分期和首诊T分期每增加1个等级，愈合尚可的概率分别是愈合差的0.370倍(OR=0.370,P=0.021)和0.172倍(OR=0.172,P=0.003)；存在头痛症状者，愈合尚可的概率将是愈合差的0.085倍(OR=0.085,P=0.017)；接受手术治疗者，愈合尚可的概率将是愈合差的12.965倍(OR=12.965,P=0.006)。此外，Mann-Whitney U检验分析显示，与非手术组比较，手术组愈合较好(W=255.0,P=0.011)，且手术组在改善患者影像评分(W=601.5,P=0.001)和患者头痛症状方面均显著，差异具有统计学意义(W=621.5,P＜0.001)。结论 头痛、是否手术、放射性鼻咽颅底骨坏死分期、首诊T分期是影响鼻咽癌放疗后颅底坏死患者预后的4个独立因素，其中手术治疗是保护因素，其余3项是危险因素。鼻内镜手术是治疗鼻咽癌放疗后颅底坏死的优选方案，对患者实施个体化、早期干预策略，有助于提高患者预后及生存质量。

Abstract:

Objective To explore the treatment strategies and the influence of relevant factors on prognosis by retrospectively analyzing cases of skull base osteoradionecrosis in nasopharyngeal carcinoma (NPC). Methods The clinical data of 60 patients with skull base osteoradionecrosis in NPC who visited the Department of Otorhinolaryngology Head and Neck of the People’s Hospital of Guangxi Zhuang Autonomous Region from June 2018 to June 2024 with complete follow-up imaging data were collected. Among them, there were 21 cases in the non-surgical treatment group and 39 cases in the surgical treatment group. Binary logistic regression analysis was used to analyze the influence of multiple factors on prognosis, and the Mann-Whitney U test was used to analyze the improvement of wound healing and headache symptoms by surgical intervention. Results Binary logistic regression analysis showed that for every increase in the stage of skull base osteoradionecrosis and the initial T stage, the probability of acceptable healing was 0.370 times (OR=0.370, P=0.021) and 0.172 times (OR=0.172, P=0.003) that of poor healing respectively. For those with headache, the probability of acceptable healing was 0.085 times (OR=0.085, P=0.017) that of poor healing. For those who underwent surgery, the probability of acceptable healing was 12.965 times (OR=12.965, P=0.006) that of poor healing. In addition, the Mann-Whitney U test analysis showed that compared with the non-surgical group, the surgical group had better healing (W=255.0, P=0.011). Surgical treatment significantly improved the patient’s imaging score (W=601.5, P=0.001) and headache symptoms (W=621.5, P＜0.001), with statistically significant differences. Conclusions Headache, whether to undergo surgery, the stage of skull base osteoradionecrosis, and the initial T stage are four independent factors affecting prognosis of patients with skull base osteoradionecrosis for NPC. Among them, surgery is a protective factor, while the others are risk factors. Endoscopic nasal surgery is the preferred treatment option for skull base osteoradionecrosis in NPC. Implementing individualized and early intervention strategies for patients can help improve the prognosis and quality of life.