声门上型喉鳞癌94例临床特征及预后分析

Clinical characteristics and prognosis of 94 patients with supraglottic laryngeal carcinoma

目的:总结声门上型喉癌的临床特征,分析其预后的影响因素。方法:声门上型喉鳞癌94例。Kaplan-meier曲线行生存分析,Cox回归模型行多因素分析。结果:声门上型喉癌首发症状以声嘶最常见(47例,50.0%),其他依次为咽部不适(30例,31.9%)、颈部肿物(15例,16.0%),呼吸困难(2例,0.2%)。初诊时淋巴结转移发生率高(36例,38.3%),患者多处于疾病晚期(Ⅲ、Ⅳ期76例,80.9%)。原发灶根治性治疗主要采取声门上水平喉半切除术或喉全切除术(58例,61.7%),余患者采取姑息性气管切开术,或姑息化疗、放疗。声门上型喉癌的总体5年生存率为41.55%。Cox回归多因素分析显示,影响声门上型喉癌预后的独立因素为T分期(W=7.308,P=0.006)、是否手术(W=26.538,P=0.000)。结论:声门上型喉癌早期诊断率较低,疾病进展快,预后差。早期发现并控制原发灶对改善声门上型预后存在重要意义。

OBJECTIVE： To summarize the clinical symptoms of supraglottic laryngeal carcinoma, and analyze prognostic influencing factor of supraglottic laryngeal carcinoma. METHODS： All the patients pathologically diagnosed as laryngeal squamous cell carcinoma （n= 94）. Survival outcomes were calculated using the Kaplan-Meier method. Predictors of outcome were identified using multivariate analysis. RESULTS： Among the initial symptoms of supraglottic laryngeal carcinoma, hoarseness was the most common （47 cases, 50.0%）, the others were throat discomfort （30 cases, 31.9%）, neck mass （15 cases, 16.0%）, and dyspnea （2 cases, 0.2%） in sequence. When diagnosed for the first time, lymph node metastasis incidence was high （36 cases, 38. 3%）, the patients were mostly in end stage （76 cases in stage Ⅲand Ⅳ, 80.9%）. The radical treatment of primary tumor mainly used supraglottic horizontal hemilaryn- gectomy or total laryngectomy （58 cases, 61.7%）, as to the other patients, palliative tracheotomy, or palliative chemotherapy, radiotherapy were used. The total 5-year overall survival （OS） of supraglottic laryngeal carcinoma was 41.55%. Cox regression multi-factor analysis showed the independent factors influencing supraglottic laryngeal carcinoma prognosis were T stage （W=7. 308, P= 0. 006）, whether surgery （W= 26. 538, P = 0. 000）. CI）NCLUSIONS： The early diagnosis rate of supraglottic laryngeal carcinoma is relatively low with rapid disease progression and poor prognosis. Early detection and radical control of the primary tumor will significantly improve the prognosis of supraglottic laryngeal carcinoma.