喉咽鳞癌不同治疗方案对喉功能保留及预后的影响  

Study on preservation of laryngeal function and prognosis after different treatment modalities in hypopharyngeal squamous cell carcinoma patients

作　　者：田文栋[1] 曾宗渊[1] 陈福进[1] 伍国号[1] 郭朱明[1] 李浩[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心头颈科,广东广州510060

出　　处：《中华肿瘤防治杂志》2007年第1期57-59,63,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：广东省医学科研基金(A2002226);广东省社会发展科技领域科技计划[粤科社字(2002)254-3]

摘　　要：目的:回顾性分析初治的97例喉咽鳞癌患者应用不同治疗方法后的生存率、喉功能保留率和复发与转移情况等,探索更合理的处理方法。方法:采用SPSS10.0统计软件Kaplan-Meier法和Pearsonχ2检验/Fisher’s确切概率比较单纯放疗组30例,新辅助化疗+放疗组17例,单纯手术组11例,手术+术后放疗组33例,姑息化疗组6例的治疗效果。结果:97例喉咽鳞癌总的3、5年累计生存率分别为46.43%和31.88%,中位生存时间是28个月。单纯放疗组、新辅助化疗+放疗组、单纯手术组、手术+术后放疗组5年生存率分别是18.33%、23.53%、36.36%和53.65%,5年复发率分别是70.00%、52.94%、36.36%和27.27%。接受原发灶手术共41例,喉功能部分或全部保留的手术患者与全喉切除术不保留喉功能的患者的5年生存率分别是57.14%、39.16%,P=0.3574;两组的5年局部复发率分别是21.05%、13.64%,差异均无统计学意义,P=0.4140。结论:喉咽鳞癌患者接受单纯放疗或新辅助化疗+放疗生存率较低,单纯手术治疗也不能明显提高生存率,手术+放疗的治疗模式可使患者生存率有明显提高,部分喉咽鳞癌肿瘤局限,可考虑行保留喉功能的喉部分切除术,并不增加复发的风险。OBJECTIVE：To review the experience for a consecutive cohort of 97 patients with previously untreated hypopharyngeal squamous cell carcinoma, to evaluate the survival, relapse and larynx preservation of several treatment modalities and to seek more reasonable therapeutic modality. METHODS： Outcome measures were calculated using the Kaplan-Meier estimator and Pearson Χ^2 test/Fisher＇s exact test by SPSS 10.0 statistic software. Of theses patients, 30 patients had radiotherapy, 17 patients had neo-adjuvant chemotherapy plus radiotherapy, 37 patients had surgery alone, 33 patients had surgery plus radiotherapy, and 6 patients had palliative chemotherapy, RESULTS： The 3-year overall survival rate of the 97 patients was 46.43% ,the 5-year overall survival was 31.88%, and the median survival time was 28 months. The 5-year survival was 18. 33 % for the radiotherapy alone group, 23.53% for the neo-adjuvant chemotherapy plus radiotherapy, 36. 36% for the surgery alone group, and 53.65% for the surgery plus radiotherapy group, respectively. In the 41 patients with surgery, the 5-year survival of patients with laryngeal function preserved and no laryngeal function preserved were 57. 44 % and 39. 16% respectively, P=0. 357 4 and the 5-year local relapse rate of the two groups were 21. 05% and 13. 64%, P=0. 414 0. There was no significant difference between the two groups. CONCLUSION： The life expectancy for patients with these tumors is very poor. Results of the radiotherapy alone or chemo-radiotherapy, in these tumors, are disappointing and the surgery also cannot obviously raise the survival rate. The survival rate of radical surgery with postoperative radiotherapy group is obviously higher than those of the other groups. The preservation of the normal part of the larynx in some patients is feasible and will not raise the risk of relapse.

关 键 词：癌 鳞状细胞/治疗 放射疗法 喉肿瘤/治疗 综合疗法 

分 类 号：R739.6[医药卫生—肿瘤]