下咽鳞癌不同治疗方案的临床分析

Long-term results of different treatment modalities in 464 hypopharyngeal squamous cell carcinoma patients

目的 探讨不同的治疗方案治疗下咽鳞癌的疗效 ,提出规范化的治疗方案。方法 回顾性分析 4 6 4例下咽鳞癌患者的临床特征和不同治疗方案的治疗结果 ,运用SPSS 10 .0软件包进行统计分析。结果 术前放疗 +手术 2 0 2例 ,手术 +术后放疗 2 2例 ,单纯手术 2 6例 ,根治性放疗失败挽救性手术 4 0例 ,单纯放疗 174例。总的 5年生存率为 34.2 % ,术前放疗 +手术组、手术 +术后放疗组、单纯手术组、根治性放疗失败挽救性手术组及单纯放疗组 5年生存率分别为 4 6 .3%、4 9.2 %、2 2 .8%、4 0 .8%和 18.0 % (P <0 .0 1)。术前放疗 +手术组与单纯手术组比较 ,生存率差异有统计学意义 (P =0 .0 4 6 )。术前放疗 +手术组喉功能保留者 80例 ,占 39.6 % ;手术 +术后放疗和单纯手术组喉功能保留者 8例 ,占 16 .7% ,差异有统计学意义 (P =0 .0 0 3)。单纯放疗组和术前放疗 +手术组死于局部复发分别为 2 7.6 %和 8.9% (P =0 .0 0 8)。结论 下咽鳞癌患者首先应选择术前放疗 +手术或手术 +术后放疗的综合治疗方案 ,术前放疗 +手术能明显提高下咽鳞癌的喉功能保留率。

Objective To present the treatment results and to identify the most effective therapeutic plan of different therapeutic modalities in patients with squamous cell carcinoma of hypopharynnx. Methods A retrospective review of 464 patients with squamous cell carcinoma of the hypopharynx treated between 1958 and 1998 was accomplished. The clinical characteristics, results of different treatments were analyzed by SPSS 10.0 statistic software. Results Of 464 patients,the age ranged from 20 to 88 years(mean 56.3 years) and the male to female ratio was 5.5∶1. The primary lesion of 383 were originated from the pyriform sinus, 40 from posterior pharyngeal wall and 41 from the postcricoid area. According to the UICC 1997 TNM staging system,75% had T3 or T4 lesion or 92.2% stage Ⅲ or Ⅳ on presentation. 65% had neck metastases. 202 patients were treated with preoperative radiation plus surgery(R+S), 22 with surgery plus postoperative radiation(S+R), 26 surgery alone(S), 40 patients with salvage surgery after radiotherapy failure(RF) and 174 patients with radiotherapy alone. The overall 5 year survival rate was 34.2%.The overall 5 year survival rate of R+S group was 46.3%, S+R group was 49.2%, S alone group 22.8%, RF group was 40.8%, radiotherapy alone group 18.0%( P <0.01). The overall 5 year survival rate of R+S group was higher than that of S alone group ( P =0.046). The rate of larynx preservation in R+S group was 39.6% in contrast to that of S+R and S alone group of 16.7%( P =0.003). Conclusion The survival rate of patients with squamous cell carcinoma of the hypopharynx treated with combined therapy(R+S or S+R) is better than the other therapeutic modalities. R+S combined is able to offer an obviously higher rate of larynx preservation(39.6% vs 16.7%).