手术为主与放疗为主综合治疗局部晚期下咽癌的疗效评价  

Comparison of Surgery Plus Radiotherapy and Radiotherapy/ Chemoradiotherapy Followed by Salvage Surgery in the Treatment for Locally Advanced Hypopharyngeal Carcinoma

作　　者：徐漫彬[1] 陈伟正[1] 杨熙鸿[1] 郭海鹏[1] 林建英[1] 彭汉伟[1] 

机构地区：[1]汕头大学医学院附属肿瘤医院,广东汕头515031

出　　处：《肿瘤学杂志》2014年第4期305-310,共6页Journal of Chinese Oncology

摘　　要：[目的]分析手术联合放/化疗和放/化疗联合挽救手术治疗局部晚期下咽癌的临床疗效,并分析影响预后的主要因素,探索其合理的治疗方法。[方法]回顾性分析1999年6月至2009年8月收治的88例下咽鳞癌患者的临床资料。按照治疗方法分为:手术联合放/化疗组(S±R/C,n=22)和放/化疗联合挽救手术组(R/C±S,n=66)。分析对比两组的总生存率(OS)、无复发生存率(RFS)和喉保留率。Cox模型分析影响预后的独立因素。[结果]S±R/C组5年OS、RFS优于R/C±S组(49.2%/45.5%vs 20.6%/17.7%,P<0.05)。喉保留率R/C±S组较S±R/C组高(95.5%vs 22.7%,P<0.05)。治疗方法是影响患者OS、RFS、喉保留率的惟一独立因素。[结论]局部晚期下咽癌采取手术联合放/化疗的生存率高于放/化疗联合挽救手术,而其喉保留率低于后者。局部晚期下咽癌的治疗首选手术为主的治疗。[Purpose] To investigate the efficacy of surgery plus radiotherapy or radiotherapy/ chemoradiotherapy followed by salvage surgery in the treatment for locally advanced hypopha- ryngeal carcinoma, and to explore an optimal treatment modality for hypopharyngeal carcinoma.[ Methods ] Clinical data of 88 cases of locally advanced hypopharyngeal carcinoma treated from Jun.1999 to Aug.2009 were retrospectively studied. The patients were divided into surgery plus radiotherapy/chemoradiotherapy group （S±R/C） and radiotherapy/chemoradiotherapy followed by salvage surgery group （R/C±S）. Overall survival, relapse free survival and laryngeal preservation rate were used to compare the treatment outcome between two groups. Cox regression model was used to analyze the independent factors for survival and laryngeal preservation rate. [Results] Survival rate was higher in S±R/C group than that in R/C±S group（5 year OS/RFS： 49.2%/45.5% vs 20.6%/17.7% ,P〈0.05）. Laryngeal preservation rate was higher in R/C±S group than that in S±R/C group （95.5% vs 22.7% ,P〈0.05）. Multivariate analysis demonstrated that treatment modality was the only independent predictor for OS, RFS and laryngeal preservation rate. [Con- clusions ] Surgery plus radiotherapy/chemoradiotherapy results in better survival and lower la- ryngeal preservation rate than radiotherapy/chemoradiotherapy followed by salvage surgery in treatment for hypopharyngeal carcinoma. Multi-disciplinary therapy based on surgery should be the first choice for the treatment of hypopharyngeal carcinoma.

关 键 词：下咽肿瘤 手术 放射治疗 喉保留 

分 类 号：R739.63[医药卫生—肿瘤]