术后辅助治疗在喉鳞癌患者中的预后价值

发布时间：2019-01-17 10:31

【摘要】：目的：探讨术后放疗、同步放化疗等辅助治疗对早晚期喉鳞癌患者预后的影响及影响其预后的相关因素，包括(1)患者自身因素：年龄、性别、术后KPS评分；(2)肿瘤因素：病理类型、肿瘤分化程度、肿瘤部位、临床分期；(3)治疗因素：术后治疗方式、放射治疗总剂量、术后治疗距手术时间、以期找到影响喉癌术后患者生存的独立预后因素，为今后更准确判断患者预后，选择更科学、有效的治疗方法提供依据。 方法：本研究属于回顾性研究，回顾性分析2000年1月至2009年12月山西省肿瘤医院放疗中心收治的463例喉癌术后患者的临床病例资料，患者治疗模式为手术±放疗±化疗，无严重术后并发症，，均获病理诊断且彩超、CT、喉镜等影像资料、随访资料完整。详细分析患者自身因素、肿瘤因素及治疗因素对预后的影响，找到影响生存的独立预后因素。Kaplan-Meier法计算生存时间及生存率，Log-rank检验进行单因素分析，Cox比例风险模型、逐步回归法进行多因素分析。 结果：本组463例喉鳞癌患者术后的中位生存时间为59.97个月，2年和5年生存率分别为86.9%和50.1%，无瘤生存率为81%和43%。术后同步放化疗较术后放疗及单纯手术可以明显提高局部喉鳞癌术后患者的总生存率。单因素分析示：患者年龄、术后KPS评分、病理分期、肿瘤类型、放疗距手术时间、放疗剂量、治疗方案是影响患者生存的重要因素。多因素分析显示：年龄（χ2＝7.349，P=0.007）、肿瘤分型（χ2＝25.655，P=0.000）、治疗方案（χ2＝15.231，P=0.000）及病理分期（χ2＝77.880，P=0.000）是影响喉癌术后患者生存的独立因素。 结论：(1)早期喉鳞癌患者无论是单纯放疗或同步放化疗均未能提高生存率，可暂不做辅助放化疗。 (2)局部晚期喉鳞癌患者术后行同步放、化疗较术后放疗或单纯手术总生存率明显提高。 (3)影响喉癌术后患者的独立预后因素为年龄、肿瘤分型、治疗方案及病理分期是影响喉癌术后患者生存的独立因素。其中年龄60岁、声门型喉癌、高分化鳞癌、临床分期较早（Ⅰ、Ⅱ期）、局部晚期喉鳞癌（Ⅲ期、Ⅳa期、Ⅳb期）术后同步放、化疗患者长期生存的有利因素。
[Abstract]:Objective: to investigate the influence of radiotherapy, concurrent radiotherapy and chemotherapy on the prognosis of patients with early and late laryngeal squamous cell carcinoma (LSCC), including (1) patients' own factors: age, sex, postoperative KPS score; (2) tumor factors: pathological type, tumor differentiation degree, tumor location, clinical stage; (3) Therapeutic factors: postoperative treatment mode, total dose of radiotherapy, time from postoperative treatment to operation, in order to find out the independent prognostic factors affecting the survival of patients with laryngeal cancer, and to judge the prognosis of patients more accurately and choose more scientifically in the future. The effective treatment method provides the basis. Methods: this study was a retrospective study. The clinical data of 463 patients with laryngeal carcinoma treated by radiotherapy Center of Shanxi Cancer Hospital from January 2000 to December 2009 were retrospectively analyzed. There were no serious postoperative complications, all were pathologically diagnosed, color Doppler ultrasound, CT, laryngoscope and other imaging data, the follow-up data were complete. The influence of patients' own factors, tumor factors and treatment factors on prognosis was analyzed in detail, and independent prognostic factors were found. Survival time and survival rate were calculated by Kaplan-Meier method, univariate analysis by Log-rank test and Cox proportional risk model. Stepwise regression analysis was carried out. Results: the median survival time of 463 patients with laryngeal squamous cell carcinoma was 59.97 months. The 2-year and 5-year survival rates were 86.9% and 50.1%, respectively. The tumor-free survival rate was 81% and 43%. The overall survival rate of patients with local laryngeal squamous cell carcinoma was significantly improved by simultaneous radiotherapy and chemotherapy compared with radiotherapy and surgery alone. Univariate analysis showed that age, postoperative KPS score, pathological stage, tumor type, radiotherapy distance from surgery, radiotherapy dose and treatment regimen were important factors affecting the survival of patients. Multivariate analysis showed that age (蠂 ~ 2 = 7.349), tumor type (蠂 ~ 2 = 25.655), treatment regimen (蠂 ~ 2 = 15.231) and pathological stage (蠂 ~ 2 = 77.880), respectively. P0. 000) is an independent factor affecting the survival of postoperative laryngeal cancer patients. Conclusion: (1) the survival rate of patients with early laryngeal squamous cell carcinoma was not improved by radiotherapy alone or concurrent radiotherapy and chemotherapy. (2) the overall survival rate of patients with locally advanced laryngeal squamous cell carcinoma (LSCC) was significantly higher than that of postoperative radiotherapy and chemotherapy. (3) the independent prognostic factors of laryngeal cancer patients were age, tumor type, treatment plan and pathological stage. Among them, 60 years old, glottic laryngeal carcinoma, well differentiated squamous cell carcinoma, early clinical stage (鈪

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