早期舌癌不同颈部处理方式对无病生存率影响的多因素分析

Multivariate analysis of impact of different neck treatment and prognostic factors affecting disease-free survival in patients with early-staged squamous cell carcinoma of tongue

目的探讨影响T1/T2N0M0期舌鳞癌患者无病生存率的影响因素,比较不同颈部处理方式对无病生存率的影响。方法回顾性调查97例舌癌患者的住院病历和随访记录,采用Cox比例风险模型对性别、年龄、T分期、原发灶治疗方式、颈部处理方式和肿瘤细胞分化程度共6个可能影响患者无病生存率的因素进行筛选,Kaplan-Meier法对各影响因素进行生存率分析并计算生存率,log-rank法比较各因素不同水平生存分布的差异。重点考察不同颈部处理方式对生存率的影响。结果T分期、原发灶治疗方式、颈部处理方式和细胞分化程度是影响患者无病生存率的主要因素,其P值分别为P<0.001、P=0.04、P=0.003、P<0.001,相对风险率分别为4.387、0.496、0.504、2.620。各有影响因素下不同水平间的无病生存率有统计学差异(P<0.05)。结论cN0患者颈部不同处理方式对患者无病生存率有明显影响,颈淋巴清扫术加放疗可减少复发风险49.6%;TNM分期对早期舌癌预后有良好的描述能力。

Objective To analyze the prognostic factors affecting the disease-free survival in T1/T2N0M0-staged patients with squamous cell carcinoma of tongue and compare the effectiveness of different neck treatment modalities.Methods 97 consecutive patients with early-staged squamous cell carcinoma of tongue were included in this study.The treatment and following-up records were reviewed retrospectively.Cox proportional hazard model was used to identify the statistically significant prognostic factors in the 6 potential factors.Kaplan-Meier method was used to estimate the disease-free survival and analyze the survival rate among the different levels,and log-rank method for comparison of the different distribution of the survival.A special focus was on the effectiveness of different neck treatment modalities.Results T stage,treatment methods of primary tumor,the modalities of neck treatment and cell differentiation were statistically significant prognostic factors.The value of P and relative risk（RR） were P〈0.001,RR=4.387; P=0.04,RR=0.496;P=0.003,RR=0.504;P〈0.001,RR=2.620,respectively.The difference of disease-free survival was statistically significant among the different levels under the different factors.Conclusion The disease-free survival was affected by neck treatment modalities remarkably in cN0 stage patients.Selected neck dissection together with adjuvant irradiation could decrease the recurrence risk by 49.6% according to the results of this study.TNM stage system could describe the characteristics of the patients with early-staged squamous cell carcinoma of tongue reasonably.