以手术为主与以放疗为主治疗Ⅲ、Ⅳ期喉癌的疗效比较

Treatment outcome comparation of surgery plus radiotherapy and radiotherapy or chemoradiotherapyplus salvage surgery for stage HI/IV laryngeal carcinoma

目的对比以手术为主和以放疗为主综合治疗方法在Ⅲ、Ⅳ期喉癌治疗中的疗效，探索Ⅲ、Ⅳ期喉癌合理的治疗方法。方法回顾性分析Ⅲ、Ⅳ期喉癌103例（Ⅲ期39例，Ⅳ期64例）的临床资料。根据治疗方法分为手术±放疗组（S±R组，46例）和放疗或放化疗±挽救手术组（R±S组，57例）。分析对比两组的总生存（OS）率、无复发生存（RFS）率和喉保留率。多因素分析影响Ⅲ、Ⅳ期喉癌患者生存率和喉保留率的独立因素。结果S±R组2年0S率、RFS率分别为74．7％（34／46）、72．4％（33／46），优于R±S组的46．4％（26／57）、40．9％（23／57）（P〈0．05）。R±S组的喉保留率高于S±R组[32．6％（15／46）比93．0％（53／57），P〈0．05）。影响预后的独立因素为治疗方法和T分期，影响喉保留率的独立因素为治疗方法。结论手术±放疗治疗Ⅲ、Ⅳ期喉癌的生存率优于放疗或放化疗±挽救手术，而前者喉保留率则低于后者。Ⅲ、Ⅳ期喉癌应以手术±放疗为首选治疗方法，生活质量的改善宜通过喉功能保留手术和发音重建的方法来实现。

Objective To compare the treatment outcome of underwent surgery plus radiotherapy and radiotherapy/chemoradiotherapy plus salvage surgery for stage Ⅲ/IV laryngeal carcinoma, to investigate an optimized treatment for the patients of stage Ⅲ/IV laryngeal carcinoma. Methods Clinical data from 103 patients with stage III （39 cases） or stage IV （64 cases） laryngeal carcinoma were retrospectively analyzed. The patients were divided into surgery plus radiotherapy group （S ±R, 46 cases） and radiotherapy/ chemoradiotherapy plus salvage surgery group （R±S, 57 cases）. Overall survival, relapse free survival, and laryngeal preservation rate were used to compare the treatment outcome between two groups. Muhivariate regression models were used to analyze the independent factors for survival and laryngeal preservation rate. Results Survival rate was higher in S±R group than in R±S group [2 year overall survival/relapse free survival 74.7 % （34/46） / 72.4 % （33/46） vs 46.4 % （26/57） / 40.9 % （23/57）, P 〈 0.05]. Laryngeal preservation rate was higher in R±S group than in S±R group [93.0 % （15/46） vs 32.6 % （53/57）, P 〈 0.05]. Multivariate analysis demonstrated that treatment modality and T stage were independent factors for long-term survival, while treatment modality was the only an independent factor for laryngeal preservation rate. Conclusions Surgery plus radiotherapy result in better survival and lower laryngeal preservation rate than radiotherapy/chemoradiotherapy plus salvage surgery in treatment of stage m/IV laryngeal carcinoma. Surgery plus radiotherapy should be the first choice for treatment of locally advanced laryngeal carcinoma. Improvement of the quality of life could be achieved by laryngeal preservation surgery and phonation reconstruction procedures.