T_3N_0M_0声门型喉癌手术治疗预后因素分析

Analysis of prognostic factors influencing surgical treatment for glottic laryngeal carcinoma of T_3N_0M_0 stage

目的探讨T3N0M0声门型喉癌手术治疗预后影响因素。方法收集81例T3N0M0声门型喉癌手术治疗病例资料,其中部分喉切除47例,全喉切除34例;15例术后放疗。采用χ2检验单因素分析和Cox比例风险回归模型进行多因素分析。结果81例T3N0M0声门型喉癌患者5年疾病特异性生存率67.1%,5年整体生存率58.0%。单因素分析显示年龄、吸烟指数、前联合累及情况、分化程度、5年内局部复发情况和术后颈部转移情况不同组间生存分布的差异具有统计学意义(P<0.05);多因素分析显示局部复发、术后颈部转移、年龄、前联合累及情况和分化程度是影响本组患者生存的独立危险因素。结论局部复发、术后颈部转移、年龄、前联合累及情况和分化程度是影响患者生存率的主要因素,对T3N0M0声门型喉癌采取预防性颈部淋巴结清扫术,重视前联合病变处理是提高患者生存率的关键。

Objective To determine the factors affecting the prognosis of glottic laryngeal carcinoma at T3N0M0 stage after surgical treatment. Methods Clinical data of 81 patients suffering from glottic laryngeal carcinoma at T3N0M0 stage was analyzed retrospectively 47 patients underwent partial laryngectomy and 34 underwent total laryngectomy. Postoperative radiotherapy was performed in l 5 cases. Univariate and multivariate studies on their clincal and follow-up data were performed with the methods of Chi- square test and Cox ＇ s proportional hazard regression model , respectively. Results The 5- year disease - specific and overall survival rates were 67. 1% and 5 8. 0 % , respectively. Univarlate results showed that the differences of patient＇s age, smoking index, anterior vocal commissure involvement, diffenrentiation of the carcinomas, local recurrence within 5 years after operation and postoperative cervical metastasis between different groups were statistically significant （ P 〈 0. 05 ） . Multivariate study indicated that non-recurrence , non-cervical metastasis , under age 65, no anterior vocal commissure involvement and well-diffenrentiation were favorable prognostic factors. Conclusion Local recurrence , cervical metastasis , patient ＇ s age , anterior vocal commissure involvement and diffenrentiation of the tumors are the major factors affecting the survival rate of patients with glottic laryngeal carcinoma at T3 N0M0 stage surgically treated. Preventive selective neck dissection, proper management of tumor- involved anterior vocal commissure are essential to improve the survival rate of patients with glottic laryngeal carcinoma at T3N0M0stage.