下咽鳞癌手术治疗及预后影响因素分析

发布时间：2018-07-09 19:46

  本文选题：下咽 + 鳞状细胞癌　； 参考：《复旦大学》2014年博士论文

【摘要】：[目的]总结分析下咽鳞癌的基本临床特点,治疗方式及预后因素,为建立下咽癌规范化手术治疗提供更多循证医学资料。[对象与方法]研究对象为2003年1月至2013年6月期间复旦大学附属眼耳鼻喉科医院耳鼻喉科收治并行外科手术治疗的下咽鳞癌病例。研究内容分为两部分。第一部分,收集所有患者发病年龄、性别、首发症状、病程、术后住院时间等临床基本信息,并对肿瘤部位、临床分期、病理组织学分级进行统计,随访患者术后生存情况,利用Kaplan-Meier法进行生存分析。第二部分,对所有下咽癌手术的原发肿瘤切除方式、颈淋巴结清扫术式、咽部缺损重建形式及术前术后综合治疗方式进行分类,比较不同治疗方式的疗效、并发症及患者预后。[结果]第一部分,本次研究共计纳入患者386例,其中男性370例(95.9%),女性16例(4.1%),患者平均年龄58.4±9.4岁。肿瘤部位：梨状窝癌296例(76.7%),咽后壁癌67例(17.3%),环后癌23例(6.0%)。肿瘤TNM分期：T1期31例(8.0%),T2期83例(21.5%),T3期175例(45.3%),T4期97例(25.1%)；NO期99例(25.6%),N1期74例(19.2%),N2期181例(46.9%),N3期32例(8.3%)；M0期383例(99.2%),M1期3例(0.8%)。肿瘤临床分期：Ⅰ期10例(2.6%),Ⅱ期29例(7.5%),Ⅲ期108例(28.0%),Ⅳ期239例(61.9%)。组织学分化程度：高-中分化355例(92.0%),低分化31例(8.0%)：发生第二原发肿瘤28例(7.3%)。Kaplan-Meier法计算3年总生存率(OS)、疾病特异生存率(DSS)和无病生存率(DFS)分别为51.8%、53.6%和49.6%,5年OS、DSS和DFS分别为45.8%、48.1%和46.0%。COX回归模型显示患者生存率的独立影响因素为T分期(p0.001)、N分期(p=0.003)、及第二原发癌(p=0.017),肿瘤复发的危险因素为原发肿瘤T分期和脉管癌栓(p0.001)第二部分,本组研究对象中375例(97.2%)为计划性手术,11例(2.8%)为挽救性手术。82例(21.2%)患者行喉功能保留手术,341例(88.3%)患者接受颈淋巴结清扫术,共399侧颈清(单侧颈清283例,双侧颈清58例)。103例(26.7%)行胸大肌皮瓣、前臂游离皮瓣、胃咽吻合术等缺损修复重建术。喉功能保留手术在T1-2期患者中的比例(22.0%)明显高于T3-4期(12.1%)(p0.001),而T3-4期病例接受修复重建手术比例(30.9%)高于T1-2期(16.7%)(p=0.004)。术前接受综合治疗者44例(11.4%),分别为6例放疗,25例化疗,13例放疗联合化疗。术后接受综合治疗者234例(60.6%),包括术后放疗90例,化疗8例,放疗联合化疗131例,靶向联合放疗1例,靶向联合放化疗4例。104例(26.9%)患者出现术后并发症,接受不同重建方式的患者生存率有显著差异(p0.001),行前臂游离皮瓣、胸大肌肌皮瓣、胃上提胃咽吻合术的患者5年OS分别为34.2%、20.9%和13.7%。而原发肿瘤切除术式、颈淋巴结清扫术式及术后综合治疗方式对患者生存率无明显影响。[结论]下咽肿瘤预后差,目前治疗方式是以手术为主的综合治疗,应行全面术前检查并对肿瘤进行严格分期,选择合适的原发肿瘤切除、颈淋巴结清扫和缺损修复重建方式。
[Abstract]:[objective] to summarize and analyze the basic clinical features, treatment methods and prognostic factors of hypopharyngeal squamous cell carcinoma (HSCC), and to provide more evidence-based medical data for the establishment of standardized surgical treatment for hypopharyngeal carcinoma. [participants and methods] patients with hypopharyngeal squamous cell carcinoma treated by Otolaryngology Hospital affiliated to Fudan University from January 2003 to June 2013 were studied. The research is divided into two parts. In the first part, we collected the basic clinical information of all the patients, such as age, sex, initial symptom, duration of disease, duration of hospitalization after operation, and made statistics on tumor location, clinical stage, histopathological grading, and survival status of the patients after follow-up. Kaplan-Meier method was used for survival analysis. In the second part, the primary tumor resection, neck lymph node dissection, reconstruction of pharynx defect and comprehensive treatment before and after operation were classified to compare the curative effect, complications and prognosis of patients with hypopharyngeal carcinoma. [results] in the first part, 386 patients were included in this study, of whom 370 were male (95.9%) and 16 were female (4.1%). The average age of the patients was 58.4 卤9.4 years old. There were 296 cases of Pyriform fossa carcinoma (76.7%), 67 cases of posterior pharyngeal wall carcinoma (17.3%) and 23 cases of posterior ring carcinoma (6.0%). There were 31 cases (8.0%) with TNM stage T1, 83 cases (21.5%) with T _ 2 stage, 175 cases (45.3%) with T _ 3 stage, 97 cases (25.1%) with no stage T _ 4, 99 cases (25.6%) with no stage, 74 cases (19.2%) with N _ 2 stage, 181 cases (46.9%) with N _ 2 stage, 383 cases (8.3%) with N _ 3 stage M _ 0 stage and 3 cases with M _ 1 stage (0.8%). There were 10 cases (2.6%) in stage 鈪，

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