联合化疗在118例晚期头颈鳞癌中的作用

Role of Combination Chemotherapy for 118 Patients with Advanced Squamous Cell Carcinoma of Head and Neck

【目的】探讨联合化疗在不能手术晚期头颈鳞癌中的作用,不同化疗方案如何选择,以及在联合化疗中应注意的问题。【方法】回顾总结了1995年1月至2005年1月间我院收治的118例不能手术晚期头颈鳞癌情况,其中男性患者102例,女16例,平均年龄为53.4岁;口咽癌19例,喉咽癌47例,舌癌52例,入院时全部为初治患者,按UICC分期全部为Ⅲ～Ⅳ患者;88例采用DBF方案化疗,30例采用TP方案化疗。【结果】118例患者中化疗评价为完全缓解CR患者有13人,占11.02%(13/118),部分缓解PR患者47人,占39.83%(47/118),总有效率(CR+PR)为50.85%。118例患者的生存情况:中位生存期位15月,用LogRank方法比较不同化疗组DBF方案和TP方案的平均生存时间,P=0.325。多因素COX模型分析表明性别、疗效和N分期是影响生存的有效因素。【结论】对于不能手术晚期头颈鳞癌患者联合化疗依然能起到一定的作用,有效率可在50%以上,提高晚期头颈鳞癌化疗疗效将有利于改善预后。

【Objective】 To assess the role of combination chemotherapy for inoperable patients with advanced squamous cell carcinoma of head and neck （A-SCCHN）, to discuss how to select a chemotherapy proposal, and to raise the correlated issues that should be paid attention to. 【Methods】 In this study, the treatment results of 118 inoperable patients with a A-SCCHN （median age 53.4 years, 102 male and 16 female, 19 cases of oropharyngeal carcinoma, 47 cases of laryngopharyngeal carcinoma and 52 cases of tongue carcinoma, all were initial-treatment patients on admission and staged Ⅲ ～ Ⅳ according to UICC classification）, treated between January 1995 and January 2005 with DBF （n = 88） and TP （n = 30）, were analyzed. 【Results】 The complete remission （CR） rate was 11.02% （13 / 118）, the partial remission （PR） rate was 39.83% （47 / 118）, and the total effective rate （CR ＋ PR） was 50.85%. The median survival time is 15 months. Log Rank approach was applied to compare the mean survival time of the two groups （DBF and TP）, P = 0.325. COX model analysis indicated gender, treatment effect and N staging significantly influenced the survival time. 【Conclusion】 Combination chemotherapy is effective to a certain extent for inoperable patients with A-SCCHN, whose effective rate is more than 50%. To improve the chemotherapy effect for patients with ASCCHN is to improve the prognosis.