中晚期下咽癌诱导化疗筛选综合治疗的单臂前瞻性研究:单中心260例报告  

A single-arm prospective study on induction chemotherapy and subsequent comprehensive therapy for advanced hypopharyngeal squamous cell carcinoma:report of 260 cases in a single center

作　　者：杨一帆[1] 王茹[1] 房居高[1] 钟琦[1] 黄志刚[1] 陈晓红[1] 张树荣[2] 高军茂 李书玲[4] 李平栋[1] 侯丽珍[1] 陈学军[1] 马泓智[1] 冯凌[1] 张洋[1] 何时知 廉猛[1] 刘术舟[5] Yang Yifan;Wang Ru;Fang Jugao;Zhong Qi;Huang Zhigang;Chen Xiaohong;Zhang Shurong;Gao Junmao;Li Shuling;Li Pingdong;Hou Lizhen;Chen Xuejun;Ma Hongzhi;Feng Ling;Zhang Yang;He Shizhi;Lian Meng;Liu Shuzhou(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Oncology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Radiotherapy,Seventh Medical Center,General Hospital of the Chinese People′s Liberation Army,Beijing 100700,China;Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otorhinolaryngology Head and Neck Surgery,Hainan Provincial People′s Hospital,Hainan 570311,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,100730 [2]首都医科大学附属北京同仁医院肿瘤科,100730 [3]中国人民解放军总医院第七医学中心放疗科,北京100700 [4]首都医科大学附属北京同仁医院影像科,100730 [5]海南省人民医院耳鼻咽喉头颈外科,570311

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第12期1143-1153,共11页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市医院管理局"登峰"人才培养计划(DFL20180202);首都卫生发展科研专项(2018-2-2054);北京市自然科学基金项目、北京市教育委员会科技发展计划重点项目(KZ201910025034);国家重点研发计划(2020YFB1312805)。

摘　　要：目的:研究诱导化疗筛选的综合治疗对于中晚期下咽癌患者生存率、喉功能保留的意义。方法:前瞻性分析首都医科大学附属北京同仁医院2011年1月至2017年12月符合入组标准的中晚期下咽癌的患者,均接受2~3周期TPF方案(紫杉醇+顺铂+5氟尿嘧啶)诱导化疗,完全缓解(complete response,CR)患者接受根治性放疗,本研究初步将部分缓解(partial response,PR)影像学评估肿瘤体积缩小达到70%及以上称大PR,行同期放化疗,小于此标准PR患者称小PR。(CR+大PR)组为TPF诱导化疗有效组,未达CR及大PR患者行根治性手术治疗,即为TPF诱导化疗无效组,术后视情况接受辅助放疗。研究终点为总生存时间(overall survival,OS)、无进展生存时间(progression free survival,PFS)、喉器官功能保全生存时间(larynx dysfunction-free survival,LDFS)。χ^2检验对影响因素进行分析;Kaplan-Meier法绘制生存曲线,采用Log-rank检验。Cox单因素分析有统计学意义者进一步行Cox多因素分析。结果:本研究最终共纳入260例患者,随访时间为24.7(5~83)个月,诱导化疗有效组和诱导化疗无效组患者的3年和5年生存率为46.0%、32.6%;无进展生存率分别为41.0%、26.6%;喉器官功能保全生存率分别为37.9%、24.8%。诱导化疗疗效差、N分期高、Ki-67免疫组化强阳性是预后不良因素(P值均<0.001)。临床分期越高,诱导化疗疗效越差(P=0.015)。大、小PR患者间OS及PFS差异无统计学意义(P值均>0.05)。结论:对于中晚期下咽癌患者进行TPF诱导化疗筛选综合治疗,可在获得较高生存率情况下尽可能保留患者有效喉功能,提高患者生存质量。Objective To study the significance of induction chemotherapy and subsequent comprehensive therapy for overall survival rate(OS)and larynx dysfunction-free survival rate(LDFS)in patients with advanced hypopharyngeal carcinoma.Methods Patients who met the inclusion criteria with the diagnoses of advanced hypopharyngeal carcinoma between 2011 and 2017 received 2 or 3 cycles of TPF regimen induction chemotherapy.Patients who attained complete response(CR)received radical chemotherapy.Patients who attained partial response(PR)and the reduction of tumor volume was more than 70%were defined as large PR and received concurrent chemoradiotherapy.When the tumor volume reduction of PR patients was less than 70%,they were defined as small PR.(CR+large PR)group was defined as effective group.Patients who did not reach CR and large PR were defined as uneffective group and underwent radical surgery and received adjuvant radiotherapy as appropriate after the surgery.The end points of the study were OS,progression-free survival(PFS)and LDFS.Chi-square(χ2)test was used for correlation analysis.Survival analysis was performed by the Kaplan-Meier method with a Log-rank test.Cox proportional hazards model was used for univariate and multivariate survival analysis.Results A total of 260 patients were enrolled in the study.The follow-up period ranged from 5 to 83 months,with an average of 24.7 months.The 3-year and 5-year OS rate was 46.0%and 32.6%,respectively.The 3-year and 5-year PFS rate was 41.0%and 26.6%,respectively.The 3-year and 5-year LDFS rate was 37.9%and 24.8%,respectively.Poor outcome of induction chemotherapy,advanced N stage,strong positive Ki-67 immunohistochemistry(all P<0.001)were negative prognostic factors.The advanced clinical stage was positively related to the poor outcome of induction chemotherapy(P=0.015).There was no significant difference in OS and PFS between the large PR group and the small PR group(all P>0.005).Conclusion TPF regimen induction chemotherapy and subsequent comprehensive therapy for patien

关 键 词：下咽肿瘤 癌 鳞状细胞 诱导化疗 综合治疗 

分 类 号：R739.63[医药卫生—肿瘤]