70岁及以上老年人喉癌发病特点及预后——155例病例回顾

The characteristics and prognosis of patients over the age of 70 with laryngeal cancer -A review of 155 cases

目的对70岁及以上喉癌患者的发病特点及预后进行探讨。方法对2006年10月至2008年10月复旦大学附属眼耳鼻喉科医院收治的70岁及以上喉癌病例共155例，进行回顾和随访。总结其发病特点，治疗方式和预后。结果全组患者共155人，平均年龄（75．7±4．8）岁，男女比例24．8：1。发病时间〈1月-600个月，中位时间4个月。声门型116人，声门上型31人，跨声门型8人。临床分期：1、2期98人，3、4期56人。术前合并症：高血压50人（32．3％），心律失常11人（7．1％），冠心病5人（3．2％），慢性阻塞性肺疾病6人（3．9％），陈旧性肺结核、支扩、哮喘、肺癌术后等其他呼吸系统疾病4人（2．6％），糖尿病11人（7．1％），贫血1人（0．6％）。治疗方式：根治性放疗13例（8．4％），显微喉镜下激光喉癌切除术14例（11．5％），部分喉切除术40例（32．8％），全喉切除术5l例（54．1％），全喉或部分喉切除术＋颈淋巴结清扫17例（13．9％），姑息手术或未治20例（12．9％），和全年龄组比较差异有统计学意义（P〈0．05）。随年龄增长，患者接受姑息治疗和主动放弃治疗的比例增高（P〈0．05）。术后并发症与患者术前合并症相关。术后一年生存率94．5％，三年生存率76．2％。术后局部复发14人（10．9％），颈部淋巴结转移9人（7．0％），远处转移6人（4．7％），与全年龄组比较差异无统计学意义（P〉0．05）。结论老年喉癌患者术前合并症发生率较高，术后并发症的发生与术前合并症相关。80岁及以上高龄老人晚期喉癌得到根治性手术的机率低。接受合适的治疗后，老年喉癌患者的治疗效果和全年龄组相同。

Objective To assess the characteristics and prognosis of patients aged over 70 years with laryngeal cancer. Method The data of 155 patients diagnosed as laryngeal cancer in Fudan EENT Hospital from Oct. 2006 to Oct. 2008 was analyzed retrospectively. Results： All 155 patient （mean age 75.7 years, male to female ratio 24.8： 1） were investigated. Onset time was from 1-600 months, and the median time was 4 months. Glottis type was 116 cases, supraglottic type was 31 cases, and cross-glottic type was 8 cases. Clinical stages： stages 1 and 2 were 98 cases, stages 3 and 4 were 56 cases. Preoperative complications： hypertension 50 cases （32.3 %）, cardiac arrhythemia 11 cases （7.1%）, coronary heart disease 5 cases （3.2%）, chronic obstructive pulmonary disease 6 cases （3.9%）, other respiratory disease 4 cases （2.6%）, diabetes mellitus 11 cases （7.1%）, and anemia 1 case （0.6%）. Treatment patterns： radical radiation therapy 13 cases （8.4%）, laserl4cases （11.5%）, partial laryngectomy 40 cases （34.4%）, total laryngectomy 51 cases （54.1%）, total/partial laryngectomy ＋ neck dissection 17 cases （13.9%）, only tracheotomy or no treatment 20 cases （12.9%）, the statistics differences were significant as compared to the whole age group （P〈0.05）. Palliative care and giving up treatment rates increased with age （P〈0.05）. Postoperative complications associated with preoperative concurrent diseases. One year survival rate was 94.5%, while three year survival rate 76.2 %. Local recurrence 14 cases （10.9%）, regional metastasis 9 cases （7.0%）, distant metastasis 6 cases （4.7%）, the statistics differences were not significant as compared to the whole age group （P〉0.05）. Conclusions Elderly patients with laryngeal cancer have higher rates of concurrent diseases. Postoperative complications associate with preoperative concurrent diseases. Patients aged over 80 with laryngeal cancer have low probability of radical surgery. With appropriate treatment, elderly patients with laryngeal cancer and patients in the whole age group have the same therapeutic outcome.