局部中晚期下咽鳞状细胞癌术后放疗与术后同步放化疗治疗的临床研究  

Clinical study of postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy for locally advanced hypopharyngeal squamous cell carcinoma

作　　者：刘坤 张欣欣[1] 刘明波[1] 王嘉陵[1] 武文明[1] 黄德亮[1] 赵建东[1] 马林[2] Liu Kun;Zhang Xinxin;Liu Mingbo;Wang Jialing;Wu Wenming;Huang Deliang;Zhao Jiandong;Ma Lin(Department of Otorhinolaryngology Head and Neck Surgery,Chinese People′s Liberation Army General Hospital,Medical School of Chinese People′s Liberation Army,Beijing 100853,China;Department of Radiotherapy,Chinese People′s Liberation Army General Hospital,Medical School of Chinese People′s Liberation Army,Bejing 100853,China)

机构地区：[1]解放军总医院解放军医学院耳鼻咽喉头颈外科,北京100853 [2]解放军总医院解放军医学院放射治疗科,北京100853

出　　处：《中华耳鼻咽喉头颈外科杂志》2019年第9期662-669,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的应用倾向性评分匹配法来评估局部中晚期下咽鳞状细胞癌(鳞癌)术后放疗和术后同步放化疗的临床疗效.方法回顾性分析2007年7月至2018年7月解放军总医院耳鼻咽喉头颈外科174例局部中晚期下咽鳞癌术后患者的病例资料,其中男168例,女6例,年龄37~79岁,中位数年龄60岁.将患者分为2组:术后放疗组和术后同步放化疗组(化疗方案为单药顺铂80 mg/m^2,第1、22、43天给药),经倾向性评分匹配,每组分别纳入61例患者进行分析.对比分析2组的局部区域控制率(loco-regional control,LRC)及总生存率(overall survival,OS)和无进展生存率(progression-free survival,PFS).生存分析采用Kaplan-Meier法及Log-rank检验.结果患者随访3~135个月,中位随访时间42个月.2组患者3年、5年LRC、PFS、OS差异无统计学意义(P值均>0.05).进一步分析发现,2组术后病理提示有预后不良因素(淋巴结包膜外受侵、淋巴结转移≥2个、切缘阳性、神经受侵或脉管癌栓)的患者,3年PFS分别为60.99%、84.49%,差异有统计学意义(P<0.05);5年PFS分别为35.47%、56.97%,差异有统计学意义(P<0.05);5年LRC分别为41.02%、68.50%,差异有统计学意义(P<0.05);3年、5年OS差异无统计学意义(P>0.05).结论针对术后病理提示有预后不良因素的局部中晚期下咽鳞癌患者,术后行同步放化疗治疗后,PFS及LRC要优于术后单纯放疗.Objective Using propensity score matching method (PSM) to investigate the clinical effect of postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy for locally advanced hypopharyngeal squamous cell carcinoma. Methods From July 2007 to July 2018, 174 postoperative patients with locally advanced hypopharyngeal squamous cell carcinoma were enrolled in pre-PSM cohort, including 168 males and 6 females, the median age was 60 years old (ranged from 37 to 79 years old). Loco-regional control (LRC), progression-free survival (PFS) and overall survival (OS) were compared and analyzed between the patients treated with postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy (cisplatin was given in a dose of 80 mg/m^2 on days 1, 22, and 43). After the propensity score matching (PSM), 61 sub-pairs of 122 patients were generated in post-PSM cohort. Survival rate were assessed with Kaplan-Meier method and Log-rank test. Results After the propensity score matching(PSM), 61 sub-pairs of 122 patients were generated in post-PSM cohort. The patients were followed up for 3-135 months, the median follow-up was 42 months. No significant differences in 3-year and 5-year LRC, PFS, OS were observed between the two groups (P>0.05). For postoperative patients who had high-risk factors (extracapsular extension of nodal disease, and/or vascular embolism, and/or lymph node metastasis≥2, and/or positive surgical margin, and/or perineural infiltration), there were significant differences between the two groups in 3-year PFS (60.99% vs 84.49%, P<0.05), 5-year PFS (35.47%vs 56.97%,P<0.05) and 5-year LRC (41.02%vs 68.50%,P<0.05), but no significant difference was found in OS between the two groups (P>0.05). Conclusion Postoperative concurrent chemoradiotherapy was more efficacious than postoperative radiotherapy alone in terms of loco-regional control and PFS for high-risk postoperative patients with locally advanced hypopharyngeal squamous cell carcinoma.

关 键 词：肿瘤分期 下咽肿瘤 癌 鳞状细胞 放射治疗 化学疗法 辅助 存活率 

分 类 号：R739.63[医药卫生—肿瘤]