术后低剂量放疗对无高危因素晚期下咽癌患者的疗效分析  

Analysis of clinical efficacy of postoperative low-dose radiotherapy in patients with advanced hypopharyngeal cancer without high-risk factors

作　　者：陶恒敏 申重 王茹[1] 魏玉梅[1] Tao Hengmin;Shen Zhong;Wang Ru;Wei Yumei(Department of Head and Neck Radiotherapy,Shandong Provincial ENT Hospital,Shandong University,Ji'nan 250023,China)

机构地区：[1]山东省耳鼻喉医院头颈放疗科,山东大学,济南250023

出　　处：《中华放射肿瘤学杂志》2023年第2期111-117,共7页Chinese Journal of Radiation Oncology

基　　金：山东省医药卫生科技发展计划项目(202009031533)。

摘　　要：目的评估低剂量放疗对术后无高危因素晚期下咽癌患者的疗效。方法回顾性分析2013年12月至2018年8月在山东省耳鼻喉医院头颈外科确诊的235例晚期下咽癌患者的临床资料。235例患者分为2组:术后低剂量放疗组(50 Gy,158例)与高剂量放疗组(>60 Gy,77例),收集患者的临床基线特征,治疗、随访及生存情况,采用Kaplan-Meier法绘制生存曲线,log-rank检验比较两组间生存情况。应用χ2检验比较两组的临床基线特征。logistic回归模型行预后影响因素的单因素和多因素分析。结果中位随访时间为45(5~94)个月。全组3年总生存(OS)率为68.5%,低剂量组和高剂量组3年OS率分别为70.3%、64.9%(P=0.356);全组3年无进展生存(PFS)率为64.3%,两组3年PFS率分别为65.8%、61.0%(P=0.361)。单因素分析结果显示,病理T分期、N分期、病变位置、病理分化程度为影响预后的因素(P<0.05),而患者年龄、性别、放疗剂量、手术与放疗间隔与预后无关。多因素分析结果显示,T、N分期和病理分化程度与3年OS和PFS均有关,为独立预后因素(P<0.05),性别、放疗剂量和手术与放疗间隔与OS、PFS无关。结论对于术后无切缘阳性和包膜外侵犯高危因素的下咽癌患者,术后瘤床和选择性淋巴结引流区给予50 Gy放疗剂量,不会降低疾病的局部控制和总生存率。Objective To evaluate the efficacy of low-dose radiotherapy in patients with advanced hypopharyngeal cancer without high-risk factors.Methods Clinical data of 235 patients diagnosed with advanced hypopharyngeal cancer treated in Department of Head and Neck Surgery of Shandong Provincial ENT Hospital from December 2013 to August 2018 were retrospectively analyzed.All patients were divided into two groups:low-dose radiotherapy group(50 Gy,n=158)and high-dose radiotherapy group(>60 Gy,n=77).Clinical baseline characteristics,treatment,follow-up and survival of patients were collected.Survival curve was delineated using the Kaplan-Meier method,and the differences in survival between two groups were calculated using the log-rank test.Clinical baseline characteristics between two groups were compared byχ2 test.Univariate and multivariate analyses of prognostic factors were conducted by logistic regression model.Results The median follow-up time was 45 months(5-94 months).The 3-year overall survival(OS)rate of the whole group was 68.5%,and 70.3%and 64.9%in the low-dose and high-dose groups,respectively(P=0.356).The 3-year progression-free survival(PFS)rate of the whole group was 64.3%,and 65.8%and 61.0%in the low-dose and high-dose groups,respectively(P=0.361).Univariate analysis showed that T stage,N stage,lesion location and degree of pathological differentiation significantly affected clinical prognosis(all P<0.05),whereas there was no significant relationship between age,sex,radiotherapy dose,interval between surgery and radiotherapy and survival.Multivariate analysis showed that T stage,N stage and the degree of pathological differentiation were the independent prognostic factors(all P<0.05)of the 3-year OS and PFS.Sex,radiotherapy dose and interval between surgery and radiotherapy were not correlated with OS and PFS.Conclusion This study showed that for hypopharyngeal cancer patients without positive surgical margins and extracapsular extension,postoperative radiotherapy at a dose of 50 Gy given to tumor bed and s

关 键 词：下咽癌 术后放射疗法 高危因素 

分 类 号：R739.63[医药卫生—肿瘤]