侵犯颈段食管的局部晚期下咽癌非手术综合治疗的疗效分析  

Efficacy of non-surgical comprehensive treatment for locally advanced hypopharyngeal carcinoma with cervical esophagus invasion

作　　者：耿泽阳 陈南翔[1] 游玮 刘坤 顾湘 魏健 马林[2] 张欣欣[1] Geng Zeyang;Chen Nanxiang;You Wei;Liu Kun;Gu Xiang;Wei Jian;Ma Lin;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;Department of Radiology,the First Medical Center,Chinese People′s Liberation Army General Hospital,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 [2]解放军总医院第一医学中心放射诊断科,北京100853

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第8期773-780,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的:分析非手术综合治疗对于侵犯颈段食管的局部晚期下咽癌患者的治疗效果和不良反应。方法:回顾性分析2011年1月至2022年5月解放军总医院耳鼻咽喉头颈外科诊治的66例侵犯颈段食管的局部晚期下咽癌患者的临床资料,其中男性65例,女性1例,年龄43~71岁。治疗方案采用诱导化疗+同步放化疗+表皮生长因子受体(epidermal growth factor receptor,EGFR)分子靶向治疗,其中3例患者使用了程序性死亡受体1(programmed cell death-1,PD-1)免疫治疗。总结患者的治疗效果及不良反应,放化疗的不良反应采用不良事件通用术语第5版进行评估,采用Kaplan-Meier法进行生存分析,并对影响预后的因素进行Cox多因素回归分析。结果:本研究64例(97.0%)患者完成了制订的放化疗方案,治疗中最常见的3级不良反应为放射性口咽腔黏膜炎(89.1%,57/64)和白细胞减少(23.4%,15/64)。治疗后可评估的64例患者中5例(7.8%)出现3级严重声音嘶哑;2例(3.1%)出现3级严重吞咽功能障碍,需鼻饲饮食及静脉营养;其余患者(89.1%)均保留了良好的发音及吞咽功能。生存分析显示:全部患者1、3、5年的总生存率分别为81.5%、54.0%、39.9%,1、3、5年的无进展生存率为78.3%、54.9%、42.6%,1、3、5年的局部控制率为80.9%、62.5%、52.0%。T4a期患者的总生存率、无进展生存率及局部控制率均优于T4b期患者,差异有统计学意义(χ^(2)值分别为8.10、8.27、6.64, P值均<0.05)。Cox多因素回归分析显示肿瘤淋巴结转移是影响预后的独立因素(χ^(2)=10.21, P<0.05)。 结论:采用非手术综合治疗方式治疗侵犯颈段食管的局部晚期下咽癌,患者获得了较高的喉及食管保留率,治疗中的不良反应可耐受。Objective To analyze the treatment effects and side effects of non-surgical comprehensive treatment for locally advanced hypopharyngeal carcinoma invading cervical esophagus.Methods A retrospective analysis was performed on sixty-six patients with locally advanced hypopharyngeal carcinoma invade the esophagus.These patients were treated in the Department of Otolaryngology,Head and Neck Surgery of Chinese People′s Liberation Army General Hospital between January 2011 and May 2022,including sixty-five males and one female,aged 43-71 years.Treatment regimen consisted of induction chemotherapy and concurrent chemoradiothrapy and epidermal growth factor receptor(EGFR)-targeted therapy,three of these cases were treated with programmed cell death 1(PD-1)immunotherapy.The Kaplan-Meier method was used for survival analysis.Side effects were evaluated with the established CTCAE(Common Terminology Criteria for Adverse Events)5.0 criteria.The factors affecting prognosis were analyzed by Cox multivariate regression analysis.Results Sixty-four(97.0%,64/66)patients completed the radiotherapy and chemotherapy plan.The most common grade three side effects were radioactive oropharyngeal mucositis(89.1%,57/64)and leukopenia(23.4%,15/64).Five(7.8%,5/64)patients showed grade three hoarseness;two patients(3.1%,2/64)suffered from grade three swallowing dysfunction and required feeding tube and intravenous nutrition;the remaining patients(89.1%)retained good vocal and swallowing functions.The overall survival(OS)of all patients was 81.5%after one year,54.0%after three years,and 39.9%after five years;the progression-free survival(PFS)was 78.3%after one year,54.9%after three years,and 42.6%after five years;local control rate(LCR)was 80.9%after one year,62.5%after three years,and 52.0%after five years.T4a patients showed better OS,PFS and LCR than T4b patients,with statistically significant differences(χ^(2)=8.10,8.27,and 6.64,respectively,all P<0.05).Cox multivariate regression analysis showed that lymph node metastasis was an independ

关 键 词：下咽肿瘤 食管侵犯 功能保护 非手术 综合治疗 

分 类 号：R739.63[医药卫生—肿瘤]