舌体鳞状细胞癌不同治疗模式疗效分析

Outcomes of tongue squamous cell carcinoma treated with different treatment modalities

目的 探讨舌体鳞癌患者不同治疗模式的治疗效果.方法 回顾分析2003-2011年间在本院首治的经病理确诊且随访资料完整的舌体鳞癌患者132例临床资料.Kaplan-Meier法计算单纯手术（S）、单纯放疗（R）、手术＋放疗（S＋R）、化疗＋手术（C＋S）、化疗＋放疗（C＋R）、手术＋放疗＋化疗（S＋R＋C）各组OS,组间差异采用Logrank法检验.Cox回归模型多因素预后分析确立有影响的治疗模式.结果 3年随访率为100％.3年样本数为94例.全组患者3年OS为72.7％.单因素分析显示70例Ⅰ＋Ⅱ期患者中S、R、S＋R、C＋S、S＋R＋C的分别为86％、67％、97％、100％、82％ （P =0.018）,62例Ⅲ＋Ⅳ期患者中S、R、S＋R、C＋S、C＋R、S＋R＋C的分别为38％、14％、92％、40％、14％、67％（P=0.000）.多因素分析显示S＋R、S＋R＋C是影响预后的因素（P=0.000、0.005）.结论 Ⅰ～Ⅱ期行手术或手术为主综合治疗疗效较好,Ⅲ～Ⅳ期行以手术为主综合治疗预后较好,其中S＋R、S＋R＋C是较好的治疗模式,对中晚期病例行R、C＋R预后差.

Objective To analyze the therapeutic effects of different treatment modalities in patients with tongue squamous cell carcinoma.Methods A retrospective analysis was performed on the complete clinical and follow-up data of 132 patients with pathologically confirmed tongue squamous cell carcinoma,who were initially treated at the First Affiliated Hospital of Xinjiang Medical University from 2003 to 2011.The Kaplan-Meier method was used to calculate the overall survival （OS） rates for patients who received surgery alone （S）,radiotherapy alone （R）,surgery plus radiotherapy （S ＋ R）,chemotherapy plus surgery （C ＋ S）,chemotherapy plus radiotherapy （C ＋ R）,and surgery,radiotherapy,and chemotherapy （S ＋ R ＋ C）.The OS was compared between these groups by log-rank test.Multivariate analysis was performed using the Cox proportional hazard model to establish independent treatment modalities as prognostic factors.Results The follow-up rate was 100%.The 3-year sample size was 94.The 3-year OS rate for all patients was 72.7%.The univariate analysis showed that among 70 stage Ⅰ and Ⅱ patients,the S,R,S ＋ R,C ＋ S,and S ＋ R ＋ C groups had 3-year OS rates of 86%,67%,97%,100%,and 82%,respectively （P =0.018） ;among 62 stage Ⅲ and Ⅳ patients,the S,R,S ＋ R,C ＋ S,C ＋ R,and S ＋ R ＋ C groups had 3-year OS rates of 38%,14%,92%,40%,14%,and 67%,respectively （P =0.000）.The multivariate analysis showed that S ＋ R and S ＋ R ＋ C were independent prognostic factors （P =0.000 and 0.005）.onclusions Surgery alone or combination therapy including surgery has a good therapeutic effect for stage Ⅰ-Ⅱ tongue squamous cell carcinoma,while S ＋ R and S ＋ R ＋ C are better treatment modalities for stage Ⅲ-Ⅳ disease;however,advanced patients have a poor prognosis after being treated with R and C ＋ R modalities.