咽部梭形细胞鳞状细胞癌的临床及预后分析  

Clinical and prognostic analysis of spindle cell squamous carcinoma of pharynx

作　　者：黄佳丽 刘梓琪 徐娟[1] 陈曦[1] 张立庆[1] 周涵[1] HUANG Jiali;LIU Ziqi;XU Juan;CHEN Xi;ZHANG Liqing;ZHOU Han(Department of Otolaryngology,The First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院/江苏省人民医院耳鼻咽喉科,江苏南京210029

出　　处：《山东大学耳鼻喉眼学报》2025年第2期94-100,139,共8页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：江苏省卫生健康委面上项目(H2019001)。

摘　　要：目的 探讨咽部梭形细胞鳞状细胞癌的临床病理特征、诊断、治疗及预后,以提高对该肿瘤的诊疗水平。方法 对美国SEER数据库的患者数据与南京医科大学第一附属医院2014年至2021年收治的咽部梭形细胞鳞状细胞癌患者进行回顾性分析。将SEER数据库中的梭形细胞鳞状细胞癌患者与普通型鳞状细胞癌患者的数据进行倾向得分匹配(propensity score matching, PSM),产生配对数据后采用Kaplan-Meier进行生存分析,分析2组间总生存期差异;并采用卡方检验、Cox风险比例模型分析临床危险因素与预后的关系。结果 本院7例患者均为男性,平均年龄60岁,其中下咽部病例5例,鼻咽部病例2例。治疗以手术为主,辅助放化疗。数据库资料经PSM后生存分析显示,咽部梭形细胞鳞状细胞癌患者生存率明显差于普通型鳞状细胞癌,差异具有统计学意义(χ^(2)=61.84,P<0.001)。单因素回归分析显示种族、TNM分期、T分期和M分期与总生存时间有关(P<0.05);多因素回归分析显示种族与M分期是影响咽部梭形细胞鳞状细胞癌患者总生存时间的独立危险因素(P<0.05)。结论 咽部梭形细胞鳞状细胞癌较普通型鳞状细胞癌罕见且预后差,种族与远处转移是影响预后的独立危险因素。临床上对该类患者应采取以根治性手术切除为主的综合治疗模式,并定期复查,终身随访。Objective To investigate the clinicopathological features,diagnosis,treatment and prognosis of patients with spindle cell squamous carcinoma,in order to improve the level of diagnosis and treatment of this tumor.Methods Between 2014-2021,patients from the First Affiliated Hospital of Nanjing Medical University with spindle cell squamous cell carcinoma were analyzed alongside patient data from the SEER database of America retrospectively.The propensity score matching(PSM)analysis was performed between patients with spindle cell squamous cell carcinoma and those with squamous cell carcinoma in the SEER database,and Kaplan-Meier survival analysis was performed to analyze the difference in overall survival between the two groups.Chi-square test and Cox risk model were used to analyze the relationship between clinical risk factors and prognosis.Results All patients were male with an average age of 60,including 5 cases of hypopharynx and 2 cases of nasopharynx.The main treatment is surgery,accompanied by chemoradiotherapy.Survival analysis after PSM showed that the survival rate of spindle cell squamous carcinoma of pharynx was significantly worse than common squamous cell carcinoma(χ^(2)=61.84,P<0.001).Univariate analysis showed that race,TNM stage,T stage and M stage were related to overall survival(P<0.05).Multivariate regression analysis showed that race and M stage were independent prognostic factors for patients with spindle cell squamous carcinoma of pharynx(P<0.05).Conclusion Spindle cell squamous carcinoma of pharynx is rarer than common squamous cell carcinoma with poor prognosis.Race and distant metastasis are important prognostic indicators.And comprehensive treatment mode,regular review and lifelong follow-up should be adopted for these patients.

关 键 词：头颈部肿瘤 咽部 梭形细胞鳞状细胞癌 倾向得分匹配 预后因素分析 

分 类 号：R766[医药卫生—耳鼻咽喉科]