喉鳞癌治疗后复发50例临床分析

Analysis of clinical and pathological factors on recurrence in laryngeal squamous cell carcinomas after laryngectomy

目的：对50例喉鳞癌复发患者的相关临床及病理因素进行分析，探讨首次治疗方法及病理情况与肿瘤复发间的关系。方法：分析江苏省肿瘤医院1992年至2008年所收治的50例复发性喉鳞癌患者的临床及病理资料。结果：复发性喉鳞癌共50例，其中局部复发21例（42％），颈部淋巴结转移27例（54％），局部复发并颈淋巴结转移2例（4％）；复发喉鳞癌病理中Ⅰ～Ⅱ级19例（38％），Ⅲ～Ⅳ级31例（62％）；局部病灶T1-224例（48％），T3-426例（52％）；首次治疗全喉或近全喉切除21例（42％），其他治疗如部分喉切除20例（40％），放化疗等9例（18％）。再次治疗采取部分喉切除、全喉切除及（或）淋巴清扫术合并放化疗。其中局部复发组5年生存率33．33％（7/21），颈淋巴结转移组5年生存率29．63％（8/27），局部复发并颈淋巴结转移组5年生存率0％（0/2）。术后复发时间8～42个月，中位复发时间13个月。结论：喉鳞癌治疗后复发同病理分级、首次治疗方法有相关性，与局部病灶分期无明显相关性，对复发喉鳞癌的治疗应以根治手术为主配合放化疗，可提高治愈率及生存率。

Objective： To evaluate the clinical and pathological factors of recurrent in 50 laryngeal carcinoma patients after treatment .To compare the relation between the first treatment methods and recurrence of carcinoma . Methods： Fifty cases of recurrent laryngeal carcinoma with clinical and pathological data were analysed retrospectively in our hospital between 1992 and 2008.Results： Fifty cases of recurrent laryngeal carcinoma ,included 21 cases of local recurrence , 27 cases of neck lymph node metastasis , 2 caese of local recurrence and neck lymph node metastasis;The pathology of recurrent laryngeal carcinoma , included 19 cases of gradeⅠ-Ⅱ, 31 cases of grade Ⅲ-Ⅳ;24 cases of T1-2 local clinical stage , 26 cases of T3-4 local clinical stage; Initial therapy included 21 cases of total laryngectomy and subtotal laryngectomy , and 29 cases of other therapy of partial laryngectomy and radiation therapy and/or chemical treatment . Retreatment included total laryngectomy and subtotal laryngectomy and/or lymph node dissection and/or radiation/chemical treatment.Among the groups, included 33.33%（7/21） of five-year survival rate in local recurrence , 29.63%（8/27） of five-year survival rate in neck lymph node metastasis , 0%（ 0/2 ） of five-year survival rate in local recurrence and neck lymph node metastasis.The postoperative recurrence time was sustained from 8 to 42 months,and the median recurrence time was 13 months.Conclusion： Pathologic type and initial therapy were important risk factors of recurrence after laryngectomy in prognostic factors and local clinical stage is not a important risk factors .The principal treatment is surgery and supplemented by a comprehensive treatment of radiation therapy and （ or ） chemical treatment for recurrent laryngeal carcinoma .