诱导化疗与手术综合治疗对中晚期下咽癌的疗效比较  

Comparative analysis of clinical efficacies between induction chemotherapy and surgery combined with radiotherapy or concurrent chemoradiotherapy in advanced hypopharyngeal carcinoma

作　　者：李振东[1] 路铁 Li Zhendong;Lu Tie(Department of Head and Neck Surgery,Liaoning Tumour Hospital,Shenyang 110042,China)

机构地区：[1]辽宁省肿瘤医院头颈外科,沈阳110042

出　　处：《中华耳鼻咽喉头颈外科杂志》2018年第12期918-924,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的比较诱导化疗与手术综合治疗两种治疗模式治疗中晚期下咽癌的临床疗效,以期为下咽癌患者选择更为恰当的治疗方式提供参考。方法回顾性分析2011年1月至2016年12月在辽宁省肿瘤医院头颈外科收治的92例下咽癌患者,所有患者治疗前确诊为下咽鳞状细胞癌,临床分期为Ⅱ期3例,Ⅲ期33例,Ⅳ期56例,治疗前均行电子食管镜检查,除外合并食管癌患者。向患者及家属交代治疗方法后由其自愿选择治疗方式,治疗方式为A:诱导化疗敏感+放疗或同步放化疗或诱导化疗不敏感+手术治疗;B:首选手术治疗后辅助放疗或同步放化疗,两种治疗方式均同步给予控制不良反应药物。采用寿命表法计算患者总生存率(overall survival,OS),Kaplan-Meier法进行生存分析,组间差异采用Log-rank法检验。采用交叉表格法比较A、B两组患者1、3、5年OS及保喉率,非参数检验为χ2检验。结果A组共纳入52例患者,经过2周期TPF[多西他赛(docetaxel,T);顺铂(cisplatine,P);氟尿嘧啶(5-Fu)]诱导化疗后,原发灶缩小≥50%为敏感病例46例(其中5例肿瘤消失);原发灶缩小<50%为不敏感病例6例。46例敏感患者根据其身体状况给予放疗或同步放化疗;6例不敏感患者行手术治疗,其中行喉全切除5例,喉部分切除1例。A组52例患者1、3、5年OS分别为91.93%、49.59%、37.20%,保喉率为90.4%(47/52)。B组首选手术共纳入40例患者,其中行喉全切除33例,喉部分切除7例。B组40例患者1、3、5年OS分别为77.50%、57.86%、43.41%。保喉率为17.5%(7/40)。交叉表格法计算A组1年OS优于B组,差异有统计学意义(χ^2=4.349,P=0.037),两组3、5年生存率差异无统计学意义。A组保喉率优于B组,差异有统计学意义(χ^2=49.539,P<0.001)。结论对于中晚期下咽癌患者根据诱导化疗是否敏感,选择放疗、同步放化疗或手术治疗,可以有效治疗肿瘤,并在最大程度上保留患者喉功能,在保证较高生存�Objective To evaluate the efficacies of different treatment modalities for patients with advanced hypopharyngeal cancers, which were treated by induction chemotherapy and surgery combined with radiotherapy or concurrent chemoradiotherapy. Methods A retrospective analysis was performed on the complete clinical and follow-up data of 92 patients with pathologically confirmed hypopharyngeal squamous cell carcinoma treated at Liaoning Tumor Hospital from January 2011 to December 2016. The tumor clinical staging was as follows: stage Ⅱ in 3 cases, stage Ⅲ in 33 cases, and stage Ⅳ in 56 cases. All patients underwent electronic esophagoscopy before treatment to remove esophageal cancer patients. The patients and their families chose voluntarily their desirable treatments from following modalities: A. Induction chemotherapy sensitivity plus radiotherapy or concurrent chemoradiotherapy, otherwise induction chemotherapy insensitivity plus surgical treatment;B. Surgical treatment plus radiotherapy or concurrent chemoradiotherapy, with drugs to control adverse reactions. The Kaplan-Meier method was used to calculate OS rates and Log-rank test was used to compare the OS rates between the two groups. Crosstabs was used to compare the difference in the 1, 3 and 5-year OS rates and the organ preservation rates between group A and group B, using chi-square test as non-parametric test. Results Fifty-two patients were enrolled in group A, after 2 cycles of induction chemotherapies with TPF(docetaxel, cisplatine, 5-Fu), there were 46 sensitive cases with primary lesions reduced by ≥50% (including 5 cases with tumor complete response) and 6 insensitive cases with primary lesions reduced by <50%.The 46 sensitive patients were treated with radiotherapy or concurrent chemoradiotherapy according to their physical conditions and 6 insensitive patients treated with surgery, including total laryngectomy for 5 cases and partial laryngectomy for one case. The 1, 3,and 5-year OS for 52 patients in group A were 91.93%, 49.59%, and 37.20%

关 键 词：下咽肿瘤 癌 鳞状细胞 综合治疗 

分 类 号：R739.63[医药卫生—肿瘤]