下咽癌178例临床病理特征及预后分析

Clinicopathological and prognostic analysis of 178 patients with hypopharyngeal cancer

目的探讨下咽癌的临床病理特征及影响下咽癌治疗预后的因素。方法回顾分析2000年1月至2006年12月浙江省肿瘤医院收治的178例下咽癌患者的临床病历资料。生存率采用Kaplan—Meier方法（KM法）统计。结果KM法统计178例患者下咽癌预期生存时间中位数为42．8个月（1～127个月），3年和5年生存率分别为47％和35％，各期5年生存率分别为I＋Ⅱ期76．2％，Ⅲ期46．7％，IV期29．6％。14．0％（25／178）患者合并第二原发肿瘤，其中同时多原发癌18例，异时多原发癌7例。影响下咽癌患者生存的因素分别为T分级（x^2=27．994，P〈0．01）、N分级（x^2=31．663，P〈0．01）、临床分期（x^2=22．267，P〈0．01）、功能状态评分（x^2=48．856，P〈0．01）、吸烟指数（x^2=8．085，P〈0．01）和治疗方法（x^2=105．528，P〈0．01）。Cox多因素分析证实吸烟指数、肿瘤分期和治疗方法是影响预后的独立危险因素。保留喉功能的治疗手段所占的比例在逐年上升，由2000年的38．5％提高至2006年的60．0％。结论手术联合放疗是治疗下咽癌的重要手段。肿瘤分期和治疗方法可作为评价下咽癌预后的重要指标。

Objective To study the clinicopathological characteristics and the prognostic factors in patients with hypopharyngeal cancer. Methods Clinical and pathological data of 178 cases with hypopharyngeal cancer from January 2000 to December 2006 were studied. Results Of the 178 hypopharyngeal cancer, the median survival time was 42. 8 months （ 1 - 127 months ）. Total 3- and 5-year survival rates were 47% and 35% , respectively. The 5-year survival rates of stage I ＋ II , stage m and stage IV were 76. 2%, 46. 7% and 29. 6%, respectively. The second primary carcinoma occurred in 14. 0% patients （25/178）, of them 18 patients with synchronous carcinoma and 7 patients with metachronous carcinoma. The independent risk factors associated with the prognosis of these patients were T staging, N staging, clinical staging, performance status （PS） , smoking index and treatment model （all P〈0. 01 ）. Multivariate Cox analysis showed that smoking index, staging of tumor and treatment were independent risk factors of prognosis. The rate of larynx function preservation was increasing with years from 2000 to 2006. Conclusions Surgery plus radiotherapy is the most important treatment for the patients with hypopharyngeal cancer. Tumor stage and treatment model are important predictors of survival in patients with hypopharyngeal cancer.