早期声门型喉癌放射治疗的预后因素分析

Prognostic factors of early glottic cancer treated with definitive radiotherapy

目的 分析单纯放射治疗早期声门型喉癌 (T1N0M0 )的预后因素。方法 195 8年 8月至 1994年 12月 ,肿瘤医院共收治行单纯放射治疗的T1N0M0声门型喉鳞癌 2 38例 ,其中男性 2 2 0例 ,女性 18例。用 6、8MVX射线或60 Co予平行对穿野放射治疗 ,中位放射总剂量为 6 8Gy ,中位治疗时间5 2d ,中位放射野大小 2 2 .5cm2 。用Kaplan Meier法计算生存率和局部控制率 ,Logrank法做差异检验 ,Cox回归法统计影响局部控制率 (LC)和总生存率 (OS)的预后因素。结果 中位随访时间 12 7个月 (4～ 410个月 )。 5、10年总生存率分别为 84.0 %和 74.9%。 5年局部控制率为 82 .2 %。 44例在随访过程中出现局部复发 (4 1例为原发部位复发 ,2例为颈部淋巴结复发 ,1例因失访复发部位不详 ) ,2 3例出现第二原发肿瘤。对LC不利的预后影响因素为局部大肿块、前联合受侵和治疗过程中血红蛋白下降。结论 单纯放射治疗T1N0M0声门型喉癌可得到很好的局部控制率 ,但局部大肿块、前联合受侵和血红蛋白在治疗过程中下降是对局部控制不利的预后因素。

Objective To analyze the prognostic factors of early glottic cancer (T1N0M0) treated with radiotherapy alone. Methods From 1958-1994, 238 patients (220 male) with T1N0M0 (UICC 1997) squamous cell carcinoma of the glottis were treated with radiotherapy alone through parallel opposing fields (median size, 22.5 ?cm 2) to a median dose of 68?Gy over a median of 52 days. Loco-regional control (LC) and overall survival (OS) rates were estimated by the Kaplan-Meier method. Logrank and Cox regression analyses were used to identify the prognostic factors. Results The median follow-up time was 127 months (range, 4-410 months). The 5- and 10- year OS rates were 84.0% and 74.9%. The 5-year LC rate was 82.2%. Forty-four patients developed recurrent disease (41 locally, 2 in cervical lymph nodes, 1 lost to follow-up); 23 had second malignancies. Unfavorable prognostic factors of LC were bulky tumor (P=0.023), anterior commissura involvement (P=0.024), and reduction of hemoglobin during treatment (P=0.025). Conclusions Radiotherapy alone provides good control for early glottic cancer. However, the negative prognostic factors for LC are bulky tumor, anterior commissura involvement and reduction of hemoglobin during treatment.