83例下咽癌临床分析

发布时间：2018-03-23 18:44

本文选题：下咽癌　切入点：生存率　出处：《广西医科大学》2011年硕士论文

【摘要】：目的探讨下咽鳞癌不同治疗方式的疗效及其生存分析,为下咽癌的治疗提供更好的临床依据。方法回顾性研究1999年1月1日至2007年10月31日期间在广西医科大学附属肿瘤医院头颈外科及放疗科住院治疗的83例下咽鳞癌患者。83例分为三个治疗组,S+R组32例,S+R+C组27例,S+C组24例。83例中原发灶位于梨状窝59例、咽后壁17例、环后7例;鳞癌Ⅰ、Ⅱ、Ⅲ级各为12例、28例、43例;临床分期Ⅰ期10例、Ⅱ期21例、Ⅲ期12例、Ⅳ期40例。下咽癌总体生存曲线采用Life Tables法,下咽癌预后各临床因素的比较采用Kaplan-Meier法计算生存率,用log-rank检验进行生存曲线差异的比较,多因素分析采用Cox逐步回归模型,计数资料用χ2检验或确切概率法,检验水准α=P,以P㩳0.05为检验有统计意义。结果1.总体上三组3、5年生存率分别为53.0%、35.8%,三种治疗方式的3、5年生存率不尽相同,其中S+R+C组最高,其次为S+R组,最低者为S+C组。S+R组、S+R+C组和S+C组的3年生存率分别为54.3%、65.4%、32.1%,5年生存率分别为37.3%、49.0%、4.6%,三种治疗方式3、5年生存率组间差异P=0.001。 2.单因素分析治疗方式的差异、颈部淋巴结转移、T分期、N分期、临床分期、病理分级为下咽癌预后相关因素,是否保留喉功能和原发灶不同与下咽癌预后无明显关系。Cox多因素统计结果表明治疗方式的差异、T分期、N分期、病理分级为下咽癌预后的独立因素。结论1.三种治疗方式中以S+R+C组3、5年生存率最高,手术结合放疗为主的治疗方式能明显提高下咽癌患者的生存率。S+R组和S+R+C组比S+C组更能提高患者3、5年生存率。S+R+C组比S+R组不能明显提高下咽癌患者3、5年生存率。 2.治疗方式的差异、T分期、N分期、病理分级可能为下咽癌预后的独立因素。颈部淋巴结转移、临床分期可能为下咽癌预后的相关因素,但可能不是下咽癌预后的独立因素。 3.下咽癌有较高的复发率和转移率,如何降低下咽癌的复发率和转移率,以及提高下咽癌复发和转移后的治疗生存率和生活质量值得进一步探讨。
[Abstract]:Objective to explore the efficacy and survival analysis of different treatment methods for hypopharyngeal squamous cell carcinoma (scscc), and to provide a better clinical basis for the treatment of hypopharyngeal carcinoma.
Methods a retrospective study from January 1, 1999 to October 31, 2007 in head and neck surgery and radiation oncology Affiliated Hospital of Guangxi Medical University hospital treatment of 83 cases of hypopharyngeal squamous cell carcinoma patients with.83 were divided into three treatment groups, 32 cases in S+R group, 27 cases in S+R+C group, S+C group of 24 cases of.83 cases of primary lesions in the pyriform sinus in 59 cases, posterior the wall in 17 cases, 7 cases of squamous cell carcinoma after ring; I, II, III in 12 cases, 28 cases, 43 cases; 10 cases of clinical stage I and II in 21 cases, 12 cases of stage III, IV in 40 cases.
The overall survival curve of hypopharyngeal carcinoma by using Life Tables method, the prognosis of hypopharyngeal carcinoma with various clinical factors compared with Kaplan-Meier method to calculate the survival rate, compare the difference in survival curves with log-rank test, multivariate analysis using Cox regression model, 2 test or exact test was used to test the level of alpha count data, =P, P 0.05? For statistical significance test.
Results of the 1. overall three year survival rate of 3,5 group were 53%, 35.8%, three kinds of treatment methods 3,5 year survival rate is not the same, the S+R+C group was the highest, followed by the S+R group, the lowest in S+C group and.S+R group, 3 year survival rate of S+R+C group and S+C group were 54.3%, 65.4%, 32.1% and the 5 year survival rates were 37.3%, 49%, 4.6%, three year survival rate of 3,5 treatment group differences P=0.001.
2. single factor analysis of the differences in the treatments of cervical lymph node metastasis, T stage, N stage, clinical stage, pathological grading for hypopharyngeal cancer prognosis related factors, whether to keep the laryngeal function and primary hypopharyngeal carcinoma with different prognosis multivariate statistical results no significant relationship between.Cox showed differences in the treatment of T stage. N staging, pathological grading and independent prognostic factors for hypopharyngeal cancer prognosis.
1. three kinds of treatment conclusions in group S+R+C to 3,5 the highest survival rate, surgery combined with radiotherapy in treatment of hypopharyngeal cancer can significantly increase the survival rate of.S+R group and S+R+C group can improve the survival rate of.S+R+C patients in 3,5 group than in the S+R group can't significantly improve the hypopharyngeal cancer patient survival rate more than 3,5 S+C group.
2., the difference in treatment modalities, T stage, N stage and pathological grade may be independent prognostic factors for hypopharyngeal carcinoma. Cervical lymph node metastasis and clinical stage may be related factors for prognosis of hypopharyngeal carcinoma, but may not be an independent prognostic factor for hypopharyngeal carcinoma.
3. hypopharyngeal carcinoma has higher recurrence rate and metastasis rate. How to reduce the recurrence rate and metastasis rate of hypopharyngeal carcinoma and improve the survival rate and quality of life after recurrence and metastasis of hypopharyngeal carcinoma is worth further exploring.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63

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