65例喉癌患者预后影响因素分析

Analysis of 65 patients with laryngeal squamous cell cancer

背景与目的:既往研究表明T分期和N分期是喉癌预后的独立影响因素。本研究回顾分析本院治疗的65例喉癌患者,进一步探讨喉癌的生存情况及预后影响因素。方法:收集2000年8月—2007年12月65例喉鳞状细胞癌患者的临床和预后资料,选择9个临床因素,通过单因素分析和Cox模型多因素分析,确定喉癌患者的预后影响因素。结果:经过中位随访期28个月,死于局部复发5例,颈淋巴结转移3例,远处转移2例,非本病死亡2例,原因不明2例。65例患者的3年生存率为74.9%,5年生存率为70.5%。单因素分析结果显示,临床总分期(P=0.021)、N分期(P=0.001)、临床分型(P=0.003)、有无复发(P=0.000)对预后的影响有统计学意义(P<0.05),而年龄、T分期、病理分级、治疗方法与患者的预后无关。Cox多因素分析结果显示,T分期(P=0.006)、淋巴结转移(P=0.025)、复发(P=0.002)和临床分型(P=0.018)是喉癌预后的独立影响因素。结论:喉癌患者预后的独立影响因素是T分期、淋巴结转移、复发、临床分型。坚持治疗后随访、及早发现肿瘤复发、及时行挽救性治疗是提高喉癌患者生存率的关键。

Background and purpose： It has been shown in the literature that T and N stage are the independent prognostic factors for laryngeal squamous cell carcinoma （LSCC）. In this study, we retrospectively analyzed 65 cases of LSCC treated in our hospital and investigated the survival rate and its prognostic factors. Methods： From August 2000 to December 2007,65 consecutive patients underwent primary surgical treatment in Cancer Hospital, Fudan University. The clinicopathologic parameters and prognosis were analyzed retrospectively. A total of 9 clinicopathologic factors were studied by univariate analysis and Cox multivariate model. Results： after a median follow-up period of 28 months, 5 patients died of local recurrence, 3 due to localregional metastasis, 2 due to distant metastasis, no-cancer related deaths in 2 cases and 2 cases of unclear reasons. The follow-up rate was 90.73% over 5 years. The overall cumulative survival rate was 74.9% at 3 years, 70.5% at 5 years. In univariate analysis, the survival was related to N status, UICC stage, location of the tumor and tumor recurrence, while age, T status, pathologic grade and types of treatment were not correlated to prognosis（P〈0.05）. In Cox multivariate modal, T status, N status, location of tumor and recurrence were independent prognostic factors. Conclusion： Independent prognostic factors for patients with LSCC after curative resection are T status, N stage, location of tumor as well as tumor recurrence. Followup after therapy and salvage therapy in time should be given to improve the survival of patients with LSCC.