声门上型喉癌术前辅助化疗的临床探讨  

Clinical Research on Neoadjuvant Chemotherapy in the Treatment of Supraglottic Carcinoma

作　　者：张强[1] 张仑[1] 张文超[1] 姚晓峰[1] 张浏阳[1] 徐本义[1] 

机构地区：[1]天津市肿瘤防治重点实验室,天津医科大学附属肿瘤医院头颈一科,300060

出　　处：《天津医药》2011年第5期430-433,共4页Tianjin Medical Journal

摘　　要：目的:探讨术前辅助化疗在声门上型喉癌的治疗中对手术切除率、淋巴结转移率、患者生存质量和预后的影响。方法:对104例声门上型喉癌行回顾性分析,按2002AJCC分期临床Ⅰ期7例,Ⅱ期30例,Ⅲ期41例,Ⅳ期26例,63例术前予化疗(Ⅰ期5例,Ⅱ期18例,Ⅲ期24例,Ⅳ期16例)。化疗前后行纤维喉镜及CT检查,化疗后1周行手术;其余41例术前无特殊处理。生存分析采用Kaplan-Meier法。结果:行术前化疗的患者,经喉镜、CT、术中评估及术后病理证实,完全缓解者(CR)9.5%,部分缓解者(PR)58.7%,总有效率(CR+PR)68.3%。术前辅助化疗较未化疗可延长患者生存时间,2组差异有统计学意义(χ2=4.726,P=0.030)。多因素分析表明N分期、组织病理分级与复发是影响生存的危险因素(OR分别为1.175、1733、2.971,均P<0.05),术前诱导化疗是保护性因素(OR=0.365,P<0.05)。结论:声门上型喉癌的预后与N分期、组织病理分级、术前化疗及复发等多因素相关。术前辅助化疗可以提高患者生存率,改善预后。Objective：To investigate the role of neoadjuvant chemotherapy on surgical resection rate,lymph node metastasis rate,survival rates the clinical prognosis in the treatment of subglottic carcinoma.Methods：Clinical data of 104 patients with supraglottic laryngeal carcinoma were analyzed retrospectively.According to the classification system of AJCC 2002,there were 7 patients in stage Ⅰ,30 patients in stage Ⅱ,41 patients in stage Ⅲ and 26 patients in stage Ⅳ.Sixty-three patients were given neoadjuvant chemotherapy,including 5 patients in stage Ⅰ,18 cases in stage Ⅱ,24 cases in stage Ⅲ and 16 in stage Ⅳ.The fiberoptic laryngoscope and CT examination were performed in patients before and after chemotherapy.The surgical operation was performed in patient after 1 week chemotherapy.There were no special treatments for the other 41 patients before surgery.The survival analysis was performed by Kaplan-Meier method.Results：There were 9.5%（6/63） completely remission（CR） and 58.7%（37/63） partial remission（PR） in patients with chemotherapy,confirmed by laryngoscope and CT examination,and assessed by surgical operation and pathological staining.The total effective rate（CR＋PR） was 68.3%.The survival time was significantly longer in patients with chemotherapy before operation than that of patients with non-chemotherapy（χ2 = 4.726,P = 0.030）.The multivariate analysis showed that N stage,pathological grade and relapse were risk factors affecting survival（P 0.05）.The neoadjuvant chemotherapy was protective factor（OR = 0.365,P 0.05）.Conclusion：The prognosis of supraglottic cancer is related to N stage,pathological classification,preoperative chemotherapy and relapse.Preoperative chemotherapy can improve the survival rate and the prognosis of patients.

关 键 词：喉肿瘤 癌 鳞状细胞 声门 存活率 抗肿瘤联合化疗方案 喉切除术 颈淋巴结清扫术 预后 

分 类 号：R737.33[医药卫生—肿瘤]