局部晚期下咽癌的预后分析

发布时间：2018-03-20 00:31

  本文选题：局部晚期下咽癌　切入点：预后　出处：《第二军医大学》2017年硕士论文　论文类型：学位论文

【摘要】：【目的】分析总结局部晚期下咽癌的临床病理特点,探讨影响局部晚期下咽癌患者预后的相关因素,对不同治疗方法进行疗效分析,为局部晚期下咽癌的治疗提供新的思路。【对象与方法】本研究的对象为2003年01月到2011年12月期间上海长海医院耳鼻咽喉头颈外科收治的局部晚期下咽鳞癌病例。课题研究分为两部分。第一部分,根据以往累积资料的统计及检索医院病例数据库,收集整理患者年龄、性别、烟酒史、病程时间、临床表现、肿瘤的部位、病理分级、肿瘤分期、是否合并第二原发癌等相关临床资料,并对患者的生存情况进行随访。根据Kaplan-Meier方法进行生存率的统计和单因素分析,并用Log-rank检验,采用Cox回归模型进行多因素分析,得出影响患者预后的独立因素。第二部分,在第一部分的基础上,收集患者术前合并症、原发灶及颈部淋巴结的处理方案、术后缺损的修复重建方式、术后并发症等资料,将所有患者按照治疗方法的不同进行分组,根据Kaplan-Meier方法进行生存率的统计,组间比较采用Log-rank检验,比较不同治疗方法的疗效。【结果】第一部分,本课题研究符合纳入标准患者共328例,其中男性312例(95.1%),女性16例(4.9%),男女比例19.5:1,平均年龄59.7±8.7岁,长期烟酒史患者共217例,占66.2%。根据解剖亚区划分,梨状窝癌267例(81.4%),咽后壁癌41例(12.5%),环后癌20例(6.1%)。分化程度:高分化鳞癌70例,中分化鳞癌193例,低分化鳞癌65例,主要病理分级为中低分化鳞癌。TNM分期:T2期61例(18.6%),T3期212例(64.6%),T4a期52例(15.9%),T4b期3例(0.9%);NO期63例(19.2%),N1期72例(22.0%),N2a期18例(5.5%),N2b期103例(31.4%),N2c期64例(19.5%),N3期8例(2.4%);M0期328例(100%)。肿瘤分期:III期119例(36.3%),IVA期198例(60.4%),IVB期11例(3.3%)。所有患者中发生第二原发癌29例(8.8%)。Kaplan-Meier方法计算患者的3年、5年总体生存率(OS)分别为56.8%和41.3%。单因素分析肿瘤分期为影响患者预后的重要因素,Cox回归模型多因素分析显示影响患者预后的独立因素为肿瘤分期(p0.05)。第二部分,根据不同治疗方法将所有入组患者分为非手术治疗组与手术治疗组。非手术治疗组中,男性患者68例(90.7%),女性患者7例(9.3%),平均年龄61.8±8.2岁。75例患者中,18例行单纯根治性放疗,8例放疗后化疗,13例TPF方案诱导化疗后行放疗,36例行同步放化疗。手术治疗组中,男性患者244例(96.4%),女性患者9例(3.6%),平均年龄59.1±8.7岁。所有手术患者均以根治性切除原发灶为基本原则,并且所有患者均行淋巴结清扫,单侧颈部淋巴结清扫63例,双侧颈部淋巴结清扫190例,共清扫443侧,术后缺损采用喉及周围粘膜、胸大肌皮瓣、前臂游离皮瓣、胃上提胃咽吻合术等进行修复重建。根据方案的不同,又将手术治疗组分为单纯手术组、术前放化疗联合手术组及手术联合放化疗组。采用Kaplan-Meier方法计算非手术治疗组及手术治疗组的3年总体生存率(OS)分别为39.8%、61.8%,5年总体生存率(OS)分别为28.0%、45.1%,经过Log-rank检验,非手术治疗组与手术治疗组疗效差异具有统计学意义(p0.05)。计算手术治疗组中不同治疗分组(单纯手术组、术前放化疗联合手术组及手术联合放化疗组)的3年总体生存率(OS)分别为40.3%、60.2%、66.2%,5年生存率分别为20.1%、44.5%、46.7%,经过Log-rank检验,三组治疗方法之间疗效差异具有统计学意义(p0.05),并且手术联合放化疗组与术前放化疗联合手术组疗效优于单纯手术组。【结论】:局部晚期下咽癌预后差。治疗前应完善相关检查并进行严格的分期,这样有利于对预后的判断。手术患者,由于本身已属晚期,存在高危因素,术后均应采取辅助放化疗,以提高手术患者的疗效。非手术患者,可以根据患者的身体状况采取同步放化疗或诱导化疗的方案。
[Abstract]:[Objective] analysis of clinical and pathological features of hypopharyngeal carcinoma summary of locally advanced, to investigate the effects of locally advanced factors related to the prognosis of hypopharyngeal cancer patients, the curative effect of different treatment methods, to provide new ideas for the treatment of locally advanced hypopharyngeal cancer. [method] with the object of this research is locally advanced in 2003 01 August to December 2011 Changhai Hospital of Shanghai otolaryngology head and neck surgery were hypopharyngeal squamous cell carcinoma cases. The study is divided into two parts. The first part, according to the statistical data and the previous cumulative hospital case retrieval database, collect the patient age, gender, smoking history, disease duration, clinical symptoms, tumor location, pathological grade, tumor stage, whether the merger of second primary cancer and other related clinical data and follow-up of patients' survival. According to Kaplan-Meier statistics of survival rate and single factor analysis, Using Log-rank test, Cox regression model was used for multivariate analysis, the independent prognostic factors. The second part, on the basis of the first part, collected from patients with preoperative complications of primary tumor and neck lymph node treatment, repair and reconstruction of defect after operation mode, data of complications after operation. All patients in accordance with the different methods of treatment group were statistical survival rate according to Kaplan-Meier method, were compared by Log-rank test, the effect of different treatment methods were compared. [results] the first part, this paper studies met the inclusion criteria of patients with a total of 328 cases, including 312 cases of male (95.1%), 16 females (4.9% 19.5:1), the proportion of men and women, mean age 59.7 + 8.7 years, a total of 217 cases of patients with long-term history of alcohol and tobacco, accounting for 66.2%. according to the anatomic sub division, pyriform sinus carcinoma in 267 cases (81.4%), 41 cases of pharyngeal cancer (12.5%), 20 cases (6.1%) after the ring. 鍖栫▼搴，

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