T4b期下咽癌非手术综合治疗77例回顾性分析  

Retrospective analysis on 77 cases of T4b hypopharyngeal carcinoma treated by non-surgical treatments

作　　者：顾湘 刘坤 苟浩成 陈南祥 张欣欣[1] Gu Xiang;Liu Kun;Gou Haocheng;Chen Nanxiang;Zhang Xinxin(College of Otolaryngology Head and Neck Surgery,Chinese People′s Liberation Army General Hospital,National Clinical Research Center for Otolaryngologic Diseases,Beijing 100853,China)

机构地区：[1]解放军总医院耳鼻咽喉头颈外科医学部国家耳鼻咽喉疾病临床医学研究中心,北京100853

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第1期22-28,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析非手术综合治疗T4b期下咽癌的有效性、安全性及影响临床预后的因素。方法回顾性分析2010年1月至2021年6月解放军总医院耳鼻咽喉头颈外科医学部收治的77例下咽癌T4b期患者的临床资料,均为男性,年龄(57.0±8.0)岁。治疗方式均采用诱导化疗+同步放化疗,总结该组患者的治疗完成率和不良反应,并利用Kaplan-Meier生存分析比较不同因素对预后的影响。同时对死亡患者的死因进行分析。结果全组77例患者76例(98.7%)完成了制订的化疗计划,73例(94.8%)完成了放疗计划。治疗过程中3级以上的不良反应发生率均不足11%,最常见的不良反应为2级放射性口腔黏膜炎(50/77,64.9%)和2级白细胞减少(50/77,64.9%)。治疗结束后76例患者喉功能保留好,3级重度声音嘶哑发生率为7.8%(6/77),有1例(1.3%)患者因吞咽困难行胃造瘘术,其余患者发音及吞咽功能都得到了有效的保留。生存分析显示,总生存率1年为71.9%,3年为45.6%,5年为29.7%。肿瘤发生部位、是否存在肿瘤原发部位的液化坏死、是否合用分子靶向药以及使用何种放疗设备是影响晚期下咽癌T4b期患者预后的独立因素[HR(95%CI)分别为1.867(1.085~3.213)、3.018(1.437~6.335)、0.372(0.181~0.764)、2.158(1.015~4.588),P值均<0.05]。发生率最高的两大死亡原因分别为疾病复发(12/32,37.5%)和颈部大血管破裂大出血(11/32,34.4%)。结论针对T4b期下咽癌,利用非手术综合治疗的方法保喉率高。此外,肿瘤发生部位、是否存在肿瘤内液化坏死、是否合用分子靶向药物、使用何种放疗设备均是影响预后的独立因素。Objective To analyze the effectiveness,safety and factors influencing the clinical prognosis of patients with hypopharyngeal carcinoma in T4b by nonsurgical treatments.Methods The clinical data of 77 patients with T4b hypopharyngeal cancer treated in the College of Otolaryngology Head and Neck Surgery of the Chinese People's Liberation Army General Hospital from January 2010 to June 2021 were analyzed retrospectively.All were males,aged(57.0±8.0)years old.Patients were treated with induction chemotherapy plus concurrent chemoradiotherapy.Kaplan Meier survival analysis was used to compare the effects of different factors on prognosis.Adverse reactions during treatments and the causes of death were analyzed.Results 98.7%of 77 patients with T4b hypopharyngeal cancer completed the chemotherapy plan and 94.8%completed the radiotherapy plan.The most common adverse reactions were grade 2 radiation oral mucositis(50/77,64.9%)and grade 2 leukopenia(50/77,64.9%).The incidence of grade 3 severe hoarseness was 7.8%(6/77),one patient(1.3%)underwent gastrostomy due to dysphagia,and pronunciation and swallowing function were effectively preserved in other patients.The overall survival rate was 71.9%at 1 year,45.6%at 3 years and 29.7%at 5 years.The location of tumor,the presence of liquefaction necrosis in tumor,the use of molecular targeted drugs and the approach of radiotherapy were independent factors,each of which that affected the prognosis of T4b patients with advanced hypopharyngeal cancer[HR(95%CI)were 1.867(1.085-3.213),3.018(1.437-6.335),0.372(0.181-0.764)and 2.158(1.015-4.588),respectively,P<0.05].The two leading causes of death with high incidence were disease recurrence(12/32,37.5%)and cervical large vessel rupture and hemorrhage(11/32,34.4%).Conclusions Non-surgical comprehensive treatment offers a high laryngeal preservation rate in patients with T4b hypopharyngeal cancer.The location of tumor,the liquefaction necrosis within tumor,the use of molecular targeted drugs,and the approach of radiotherapy are independe

关 键 词：下咽肿瘤 液化坏死 喉功能保留 分子靶向药物 

分 类 号：R739.63[医药卫生—肿瘤]