晚期喉癌术后患者行同期放化疗与单纯放疗的临床疗效比较及预后分析

Clinical Efficacy and Prognosis of Concomitant Chemo-radiotherapy and Simple Radiotherapy on Patients with Advanced Laryngeal Cancer after Laryngectomy

目的比较晚期喉癌患者喉全切或次全切术后行同期放化疗与单纯行放射治疗的临床疗效差异、探讨影响预后的相关因素。方法回顾性分析2007—2008年195例喉全切或次全切术后在郑州大学第一附属医院放疗科行放射治疗患者的临床病例资料,利用Kaplan-meier法、Log rank检验、Cox比例风险模型对患者生存率进行比较并分析影响预后的相关因素。结果 195例患者术后行同期放化疗5年生存率为68.2%,单纯放疗5年生存率为48.9%,差异有统计学意义;单因素分析结果显示:放疗剂量、年龄、治疗方案、肿瘤大小、肿瘤部位、术后至放疗结束时间、有无淋巴结转移是影响患者生存预后的因素;Cox回归分析示患者年龄、治疗方案、术后至放疗结束时间、有无淋巴结转移是影响预后的独立因素。结论年龄、治疗方案、术后至放疗结束时间、有无淋巴结转移是影响喉癌患者术后预后的独立因素。行放化疗综合治疗,术后11周内完成放射治疗计划,坚持随访,及时处理肿瘤复发、淋巴结转移有望提高生存率。

Objective To compare the clinical efficacy of concomitant chemo-radiotherapy(CRT) and simple radiotherapy on patients with advanced laryngeal cancer after total laryngectomy or subtotal resection, and to discuss the related prognostic factors. Methods We retrospectively analyzed records of 195 postoperative laryngeal cancer patients with radiation therapy in the department of radiotherapy, the First Affiliated Hospital of Zhengzhou University from Jan 1st, 2007 to Dec 30th, 2008. The methods of Kaplan-Meier, log-rank, Cox proportional hazard model were used to calculate the survival rate and prognostic factors. Results Five-year survival rates of patients underwent CRT and simple radiotherapy were 68.2% and 48.9% respectively(P<0.05). In univariate analysis, the survival and prognosis were related to radiation dose, age, treatment, tumor size, location, time between operation and the end of radiotherapy, and lymph node metastasis. In Cox multivariate model, age, treatment, time between operation and the end of radiotherapy, and lymph node metastasis were independent prognostic factors. Conclusion Age, treatment, time between operation and the end of radiotherapy, and lymph node metastasis are independent prognostic factors for patients with laryngeal carcinoma. The survival rate could be improved by taking concomitant chemoradiotherapy, radiotherapy treatment within 11 weeks after the operation, constant follow-up, timely treatment on tumor recurrence and lymph node metastasis.