下咽癌97例治疗与生存分析

发布时间：2018-01-30 07:03

  本文关键词： 下咽癌 治疗 生存分析 生存率　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析影响下咽癌患者总生存时间及无进展生存时间的危险因素,以期为临床治疗提供参考。方法回顾分析吉林大学第二医院耳鼻咽喉头-颈外科及放疗科自2008年1月1日至2016年3月1日期间所收治的病例资料完整且病理证实为下咽鳞状细胞癌的97例患者。将97例患者根据治疗方式不同分为4组,分别为单纯手术组(Surgery,S)29例,手术+放疗组(Surgery+Radiotherapy,SR)32例,单纯放疗组(Radiotherapy,R)8例和同步放化疗组(Concurrent chemoradiotherapy,CCR)28例,统计患者性别、年龄、肿瘤原发灶位置、TNM分期、临床分期、治疗方式、病理分化程度等临床资料,用Kaplan-Meier法及Log Rank检验分析上述因素与总生存时间(Overall Survival,OS)、无进展生存生存时间(Progression-Free Survival,FPS)的关系,运用Cox逐步回归模型进行多因素生存分析,p0.05认为有统计学意义,即为独立危险因素,并绘制生存曲线。结果1.临床资料:全组97例下咽癌患者,男93例,女4例,平均年龄(57.1±7.9)岁;既往有抽烟及饮酒史者分别占总数的85.6%及89.7%;肿瘤原发灶位置:梨状窝型76例(78.4%),咽后壁型13例(13.4%),环后型8例(8.2%);肿瘤TNM分期:T1-T2期共51例(52.6%),T3-T4期共46例(47.4%),N0期20例(20.6%),N1期41例(42.3%),N2-N3期36例(37.1%);临床分期:Ⅰ期-Ⅱ期11例(11.3%),Ⅲ期-Ⅳ期86例(88.7%);病理分化程度:原位癌4例(4.1%),高分化鳞状细胞癌20例(20.6%),中分化鳞状细胞癌65例(67.0%),低分化鳞状细胞癌8例(8.3%)。2.生存分析:全组患者的1年、3年、5年总生存率分别为91.8%、55.6%和39.9%,无进展生存率分别为73.6%、25.4%、3.2%;治疗方式是总生存时间(p=0.002)及无进展生存时的危险因素(p=0.003),但并非独立危险因素;影响总生存时间的独立危险因素为N分期(p=0.001);影响无进展生存时间的独立危险因素为N分期(p=0.000)及年龄分组(p=0.013)。结论1.下咽癌是一种临床发病率较低、病程进展隐匿、手术复杂、预后差的恶性肿瘤。2.约50%的下咽癌患者发病年龄为51~60岁,男性患者显著多于女性,且患者多有长期(20年)抽烟及饮酒史。3.肿瘤患者的生存时间与颈淋巴结转移情况显著相关,因治疗方式并非影响生存时间的独立危险因素,故治疗前需详细检查并综合分析。4.对于早期下咽癌患者,治疗可采用单纯手术治疗或放疗,而对于晚期可切除病变患者可采用以手术为主的综合治疗,不推荐给予高龄患者过度激进性的治疗。
[Abstract]:Objective to analyze the risk factors affecting the total survival time and progression free survival time of patients with hypopharyngeal carcinoma. Methods the data of patients in Department of Otorhinolaryngology and head and neck surgery and radiotherapy from January 1st 2008 to March 1st 2016 were analyzed retrospectively. 97 patients with hypopharyngeal squamous cell carcinoma confirmed by pathology were divided into 4 groups according to different treatment methods. There were 29 cases of Surgerysma in the simple operation group and 32 cases of surgery radiotherapysma in the radiotherapy group. There were 8 cases of radiotherapysmal RV in radiotherapy alone group and 28 cases of concurrent chemotherapy group (concurrent chemotherapy group). Gender, age, tumor location, TNM staging, clinical staging, treatment, pathological differentiation and other clinical data were statistically analyzed. Kaplan-Meier method and Log Rank test were used to analyze the above factors and total survival time. The relationship between Progression-Free Survival (FPS) and Progression-Free Survival (FPS) was analyzed by Cox stepwise regression model. Results 1. Clinical data: 97 patients with hypopharyngeal carcinoma, 93 males and 4 females. The average age was 57.1 卤7.9 years. 85.6% and 89.7of the patients had a history of smoking and drinking respectively. The location of primary tumor was: Pyriform fossa type (76 cases), posterior pharyngeal wall type (13 cases), posterior wall type (13 cases) and posterior ring type (8 cases). There were 51 cases with TNM: T1-T2 stage and 46 cases with T3-T4 stage. There were 20 cases with N0 stage and 20 cases with T3-T4 stage. There were 41 cases with N1 stage and 36 cases with N2-N3 stage. Clinical staging: stage 鈪，

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