92例晚期舌鳞状细胞癌的治疗及预后分析

Treatment and prognostic analysis of 92 cases with advanced mobile tongue squamous cell carcinoma

目的比较晚期舌鳞癌不同治疗手段的疗效并探讨影响其预后的因素。方法回顾性分析cTNM晚期舌鳞癌92例的临床及随访资料,Kaplan-Meier法计算累计生存率,Cox回归模型进行多因素分析。结果全组3年、5年生存率分别为52.40%、37.23%。单因素分析显示,单纯化疗和诱导化疗后放疗两组与单纯手术、诱导化疗后手术、手术后放疗3组间的累计生存率间差异有统计学意义;多因素分析显示cTNM分期、原发灶手术、局部区域复发是影响预后的独立因素。结论cTNM分期、原发灶手术、局部区域复发是影响晚期舌鳞癌预后的独立因素;对其行手术治疗或包含手术的综合治疗可以获得相对好的疗效,单纯化疗或化疗后放疗疗效差。

Objective To compare the results of different treatment modalities for the advanced tongue squamous cell carcinoma and investigate the factors that influence its prognosis. Methods Ninety-two patients with advanced tongue squamous cell carcinoma without distant metastasis, treated in our hospital from Jan. 1990 to Dec. 1999 were retrospectively reviewed. Survival rate was estimated by Kaplan-Meier method, and multivariate analysis was performed by the Cox Proportional hazard model . Results The overall 3-year and 5-year survival rates were 52.40% and 37.23% respectively. There was a significant difference in the overall between the two groups survival rate （chemotherapy only and radiotherapy after induced chemotherapy ） and the three groups （operation only, operation after induced chemotherapy, radiotherapy after operation ）cTNM stage, operation for the primary lesion and local recurrence were the independent factors that influenced the prognosis. Conclusions Risk factors that independently influence the survival of patients with advanced tongue squamous cell carcinoma were the local recurrence, cTNM and receiving operation or not for the primary lesion. Operation only or comprehensive therapy including operation could give a better prognosis, but the results of chemotherapy only or radiotherapy after chemotherapy were poor.