口咽鳞状细胞癌患者治疗及预后因素分析

Treatments and prognosis of patients with squamous cell carcinoma of the oropharynx

目的探讨口咽鳞状细胞癌(简称鳞癌)以手术为主和以放疗为主的两种治疗方式疗效及影响预后的因素。方法回顾性分析我院自1985年3月～2005年10月期间收治的239例病理确诊的口咽鳞癌患者的临床资料,其中173例行单纯放疗或放疗加挽救性手术,66例行单纯手术或手术加放疗。Ⅰ期患者15例,Ⅱ期45例,Ⅲ期71例,Ⅳ期108例。生存分析采用Kaplan-Meier法及Log rank检验,多因素分析采用Cox回归模型法。结果两治疗组患者3年总生存率分别为54.5%和52%,5年总生存率分别为44.9%和43.8%,两种治疗方法患者生存率差异无统计学意义(P>0.05)。I～IV期患者3年生存率分别为73.3%、70.4%、54.2%和41.3%,5年生存率分别为66%、63.1%、47.6%和30.5%。多因素分析显示临床分期、T分级、有无淋巴结转移是主要的预后影响因素。结论两种治疗方法对口咽鳞癌患者的预后相当,临床分期、T分级、有无淋巴结转移是主要的预后影响因素。

OBJECTIVE To evaluate the therapeutic outcomes of mainly-surgery or mainly-radiotherapy treatment and define the prognostic factors in patients with squamous cell carcinoma（SCC）of the oropharynx.METHODS From March 1985 to October 2005,239 patients with SCC of the oropharynx proved pathologically were eligible for the present study.One hundred and seventy three of them were treated with radiotherapy followed surgery or not（RT±S）,while 66 of them were treated with surgery followed radiotherapy or not（S± RT）.According to TNM staging system,there were 15 patents in stage I,45 in stage Ⅱ,71 in stage Ⅲ,108 in stage IV.Kaplan-Meier and Logrank tests were used for survival analysis,while Cox stepwise regression model was used for multivariate analysis of prognostic factors.RESULTS The 3-year survival rates in two treatment group were 54.5% and 52% respectively and the 5-year survival rates were 44.9% and 43.8% respectively.Difference of survival rates between the two groups was not statistically significant.The 3-year survival rates based on stage were 73.3% for stage I,70.4% for stage Ⅱ,54.2% for stage Ⅲ,41.3% for stage IV.The 5-year survival rates based on stage were 66.0% for stage I,63.1% for stage Ⅱ,47.6% for stage Ⅲ,30.5% for stage IV.Multivariate analysis showed that AJCC stage,tumor stage and nodal stage were the significant prognostic factors.CONCLUSION The survival rates of patients in two treatment groups were not statistically different.AJCC stage,primary tumor and nodal stage were the signi？cant prognostic factors.