目的：本文主要在探討鼻咽癌併遠端轉移病人之臨床表現與治療結果。材料與方法：自1991年3月至2005年9月，總共有70位鼻咽癌併遠端轉移的病人在本院接受治療，其中15位病人(76%)是男性，17位病人(24%)是女性。年齡中位數是50歲（範圍自17至87歲）。5位病人(7%)在病理報告上是屬於WHO type Ⅰ，30位(43%)是WHO type Ⅱ，35位(50%)是WHO type Ⅲ。依據AJCC 2002 腫瘤分期，2位病人(3%)是T1，11位(15%)是T2，18位(26%)是T3，39位(56%)是T4。4位病人(6%)是N0，9位(13%)是N1，10位(14%)是N2，47位(67%)是N3。有16位病人(23%)在就醫時無遠端轉移(M0)，另外54位病人(77%)則是一開始就已經有遠端轉移(M1)。在所有70位病人當中，有46位(66%)接受了鼻咽原發部位與頸部淋巴結的放射線治療或同步化學放射線治療。放射線治療劑量中位數是7380 cGy。遠端轉移的部位包括骨轉移(54%)、肝臟轉移(34%)、肺部轉移(24%)、腦部轉移(6%)，與其他部位轉移(6%)。對於轉移部位的治療方式，21位病人(30%)接受緩解性放射線治療，24位(34%)接受化學治療，5位(7%)接受拯救性手術，其餘26位病人(37%)則是接受支持療法。結果：遠端轉移之後的存活期間中位數為9.4個月（範圍自1至51.3個月）。其中有9位病人(13%)存活超過2年。以Kaplan-Meier 存活分析來統計，年齡（p值為0.0388）與遠端轉移部位（p值為0.0390）為影響出現遠端轉移後之存活率之重要預後因子。病人若是年齡小於50歲或是為骨轉移或是肺部轉移，則有較長的存活時間，相對的若病人年齡大於50歲或是為肝臟轉移或是腦部轉移，則存活時間較短。結論：以緩解性放射線治療、化學治療、拯救性手術，或是支持療法來治療鼻咽癌併遠端轉移的病人，可以達到9.4個月的存活時間。以Kaplan-Meier存活分析來統計，年齡與遠端轉移部位為影響出現遠端轉移後之存活率之重要預後因子。

Purpose: To evaluate the clinical features and the results of patients of nasopharyngeal carcinoma (NPC) with distant metastases. Materials and Methods: This study enrolled 70 patients of NPC development of distant metastases from March 1991 to September 2005. Fifty-three patients (76%) were male, and 17 (24%) were female. The median age of initial diagnosis as NPC was 50 years (ranged from 17 to 87 years). Five patients (7%) were WHO type Ⅰ nasopharyngeal carcinoma, 30 (43%) were type Ⅱ, and 35 (50%) were type Ⅲ. According to AJCC (American Joint Committee on Cancer) 2002 TNM staging system, 2 patients (3%) were T1, 11 (15%) were T2 (4 were T2a, 7 were T2b), 18 (26%) were T3, and 39 (56%) were T4. Four patients (6%) were N0, 9 (13%) were N1, 10 (14%) were N2, and 47 (67%) were N3 (32 were N3a, 15 were N3b). Sixteen patients (23%) were initially M0, and 54 (77%) were initially M1. Forty-six of all 70 patients (66%) received radiotherapy/concurrent chemoradiotherapy to the primary sites of nasopharynx and neck lymph nodes. The median cumulative irradiation dose was 7380 cGy. The sites of initial distant metastases included bone (54%), liver (34%), lung (24%), brain (6%), and others (6%). Twenty-one patients (30%) received palliative irradiation to sites of distant metastases, 24 (34%) received chemotherapy, 5 (7%) received salvage surgery, and 26 (37%) received supportive care. Results: The median duration of survival after distant metastases of all patients was 9.4 months (ranged from 1 to 51.3 months). Nine patients (13%) survived for more than 2 years. In Kaplan-Meier survival evaluation, age (p=0.0388) and metastastic site (p=0.0390) were prognostic factors for survival since distant metastasis. Patients with age less than 50 years or with bone and lung metastases had longer survival, while patients with age larger than 50 years or with liver and brain metastases had shorter survival. Conclusion: With managements of palliative irradiation, chemotherapy, salvage surgery and supportive care, the median survival was 9.4 months for patients of nasopharyngeal carcinoma developing distant metastases. Age and metastastic site were prognostic factors for survival since distant metastasis with Kaplan-Meier survival evaluation.