下咽鳞癌不同方案治疗的临床结果分析

An analysis of outcomes for hypopharyngeal squamous cell carcinoma treated with different methods

目的:分析下咽鳞癌不同方案临床治疗结果, 探讨下咽鳞癌最优治疗模式．方法:回顾分析187例下咽鳞癌临床资料,比较不同方案治疗的生存率,复发率以及喉功能保留的影响．结果:5 a总体生存率44．9％．Ⅰ-Ⅳ期5 a生存率分别为100％,81．8％,47．6％和30．2％．Ⅰ、Ⅱ期生存率高于Ⅲ、Ⅳ期(X2=22．878,P=0．000 1)．各治疗组的5 a总体生存率分别为综合治疗 60．8％,单纯手术治疗38．7％,单纯放射治疗 22．0％．综合治疗明显高于单纯手术治疗和单纯放射治疗(X2=4．651,P=0．032;X2=24．248, P=0．000 1)．Ⅲ、Ⅳ期5 a生存率分别为综合治疗75．7％和45．3％,单纯手术治疗为33．3％和 17．6％,单纯放射治疗为16．7％和7．7％．综合治疗生存率明显高于单纯手术治疗和单纯放射治疗(X2=4．290,P=0．038;X2=22．247,P= 0．000 1;X2=4．149,P=0．042;X2=11．163,P= 0．001)．总体复发率44．9％．Ⅱ-Ⅳ期的5 a复发率分别为31．8％,47．6％和49．0％．Ⅲ、Ⅳ期病例复发率为48．4％,明显高于Ⅰ、Ⅱ期的25％ (X2=5．816,P=0．016)．各治疗组中,Ⅲ、Ⅳ期病例的5 a复发率分别为单纯手术治疗60．9％, 单纯放射治疗80％,综合治疗26．7％．单纯手术治疗和单纯放射治疗的复发率明显高于综合治疗(X2=9．425,P=0．002;X2=36．064,P= 0．000 1)．高、中和低分化鳞癌的复发率分别为34．2％,50%和56．1％．低分化癌的复发率明显高于高分化癌(X2=4．977,P=0．026)．Ⅲ、Ⅳ期病例中,喉功能保留和不保留患者的5 a生存率分别为72．4%,46．2％和60．0%,36．8％．两者相比差异无显著性(P>0．05)．结论:下咽鳞癌综合治疗优于单一治疗．部分Ⅲ、Ⅳ期病例可行喉功能保留手术．

AIM： To analyze the outcomes of hypopharyngeal squamous cell carcinoma treated with different methods and to explore a more effective therapy for it. METHODS： This retrospective study concerns 187 hypopharyngeal squamous cell carcinomas and their characteristics. The survival rate, recurrence rate and influence of laryngeal preservation on the survival were compared among different therapies. RESULTS： The overall 5-year survival rate was 44.9%. The 5-year survival rates of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 100%, 81.8%, 47.6%, and 30.2%, respectively, and the former two were significantly higher than the latter two （χ^2 = 22.878, P = 0.000 1）. The overall 5-year survival rate for synthetic therapy, surgery and radiotherapy alone was 60.8%, 38.7%, and 22.0%, respectively, and the survival rates of patients at stage Ⅲ and Ⅳ were 75.5% and 45.3% for synthetic therapy, 33.3% and 17.6% in surgery alone, 16.7% and 7.7% in radiotherapy alone. The survival rates of stage Ⅲ and stage Ⅳ in patient received synthetic therapy were markedly higher than those in patient received surgery or radiotherapy （all P 〈 0.05）. The overall recurrence rate was 44.9%. The 5-year recurrence rates of stage Ⅱ, Ⅲ and Ⅳ were 31.8%, 47.6% and 49.0%, respectively, and there was a significant difference between stage Ⅲ, Ⅳ and stage Ⅰ, Ⅱ （48.4% vs 25%, ;（2 = 5.816, P = 0.016）. Significant differences were shown in the recurrence rate of stage Ⅲ, Ⅳ between synthetic therapy （26.7%） and surgery （60.9%） or radiotherapy （80 %） （all P 〈 0.01）. The recurrence rates of highly, moderately and lowly differentiated carcinoma were 34.2%, 50% and 56.1%, respectively, and there was significant differences between highly and moderately or lowly differentiated carcinoma （χ^2= 4.977, P = 0.026）. The 5-year survival rate was not significantly different between patients with laryngeal preservation and without laryngeal preservation at stage Ⅲ or Ⅳ （all P 〉 0.05）. CONCLUSION： Synthetic therapy is superior to surgery or radiotherapy alone in the treatment of hypopharyngeal squamous cell carcinoma. Laryngeal preservation can be achieved in some of patients at stage Ⅲ or Ⅳ.