口咽鳞状细胞癌318例临床分析

Clinical analysis of 318 cases of oropharyngeal squamous cell carcinoma

目的总结分析口咽鳞状细胞癌的临床病理特征、治疗效果及预后因素。方法回顾性分析1999年1月至2011年12月期间中国医学科学院肿瘤医院收治的符合入组条件的318例口咽鳞状细胞癌患者的临床病理资料，其中扁桃体区癌163例、舌根癌108例及软腭一悬雍垂癌47例，其中男281例，女37例，发病年龄中位数56岁。首发症状主要为咽部疼痛（128例，40．3％）、颈部肿块（71例，22．3％）、咽部异物感（63例，19．8％）及口腔溃疡（44例，13．8％），病程时间中位数为3个月。318例患者中，高分化肿瘤133例，中分化110例，低分化75例。临床分期为1期10例，Ⅱ期39例，Ⅲ期68例，Ⅳ期201例。采用Kaplan-Meier法、Log-rank单因素分析和Cox回归模型多因素分析法计算生存率和预后相关因素。结果本组患者颈部淋巴转移率、远处转移率及第二原发癌发生率分别为72．3％、13．2％和7．9％。治疗方式包括单纯放疗117例（36．8％），手术联合术后放疗66例（20．8％），术前放疗联合手术59例（18．6％），同步放化疗33例（10．4％），放疗联合靶向治疗20例（6．3％），单纯手术治疗16例（5．0％）及诱导化疗联合单纯放疗7例（2．2％）。全组总的3年、5年生存率分别为58．4％、50．7％，生存中位数60．1个月。经Cox回归模型多因素分析影响患者预后的独立危险凶素为发病年龄（P：0．034）、性别（P=0．024）、长期吸烟及酗酒史（P=0．008）、放疗剂量（P=0．046）及临床分期（P=0．001）。结论口咽鳞状细胞癌预后相对较差，易发生颈部淋巴转移，放射治疗和外科手术挽救是主要治疗方式。

Objective To investigate the clinicopathological features, treatment outcomes and prognosis of patients with orophai3,ngeal squamous cell carcinoma （OSCC）. Methods Retrospective review of 318 consecutive cases with OSCC treated from January 1999 to December 2011. Survival rates and prognostic factors were calculated using the Kaplan-Meier method and multivariate Cox model survival analysis respectively. There were 281 males and 37 females, with a median age of 56 years. Of the 318 cases, 163 carcinomas were from tonsil, 108 from tongue base and 47 from soft palate-uvula. The presenting symptoms were pharyngalgia（ 128 cases, 40. 3% ） , neck masses（71 cases, 22. 3% ） , foreign body sensation in the pharynx（63 cases, 19.8% ） and dental ulcer（44 cases, 13.8% ）. The median time from onset of the first symptoms until diagnosis of OSCC was 3 months. Of the 318 OSCC, 75 were with high grade, 110 with intermediate grade and 133 with low grade, including 10 patients at stage I , 39 at stage Ⅱ, 68 at stage Ⅲ and 201 at stage Ⅳ. Results The rates of lymph node metastasis, distant metastasis and second primary carcinoma were 72.3%, 13.2% and 7.9%, respectively. Of 318 patients, 117 received radiotherapy alone, 66 underwent surgery plus postoperative radiotherapy, 59 underwent preoperative radiotherapy plus surgery, 33 received concomitant chemotherapy and radiotherapy, 20 received concomitant molecular targeted therapy and radiotherapy, 16 underwent surgery alone and 7 received induction chemotherapy plus radiotherapy. The 3-, 5-year overall survival （OS） rates were 58.4%, 50. 7%, respectively, and the median overall survival time was 60. 1 months. Ages （ P = 0. 034 ） , gender （ P = 0. 024 ） , smoking and alcohol consumptions （ P = 0. 008 ） , doses of radiotherapy （ P = 0. 046 ） and clinic stages （ P = 0. 001 ） were independent factors for OS. Conclusions OSCC is poor in prognosis, with a high incidence of cervical lymphnode metastasis. Radiotherapy and salvage surgery are the main treatments for OSCC.