术前诱导化疗对晚期可手术切除的舌体鳞状细胞癌预后生存的长期影响

The effect of preoperative induction chemotherapy on long-term survival of patients with advanced squamous cell carcinoma of the oral cavity tongue

目的：探讨诱导化疗达到病理完全缓解（pCR）对可手术切除的Ⅲ/Ⅳ期舌体鳞状细胞癌患者生存和预后的长期影响。方法：选取1996-06-2005-12期间中山大学附属肿瘤医院首治、经病理检查确诊且随访资料完整、可手术切除的73例晚期舌鳞状细胞癌患者。所有患者均行三程PF（顺铂加5-FU）方案诱导化疗加手术和（或）放疗,回顾性分析其5年总生存率、局部控制率和治疗失败的可能原因。结果：全组随访时间为1.9-188.0个月,中位随访时间70.9个月,24例患者仍存活,其中23例患者生存时间大于10年。17例（23.3%）患者达到临床完全缓解（CR）,44例（60.3%）临床部分缓解（PR）,12例（16.4%）肿瘤稳定或进展,总有效率为83.6%。依据手术标本,14例（19.2%）达到pCR,59例（80.8%）病理PR。单因素分析示：肿瘤大小、有无区域淋巴结转移、临床分期、不同疗效反应和有无pCR是影响患者生存的独立因素（P〈0.05）。多因素分析示：颈部淋巴结转移、不同化疗疗效反应和有无pCR是影响患者预后生存的重要因素（P〈0.05）。所有患者5年总体生存率（OS）为59.8%,22例（30.1%）复发,局控率为69.9%。诱导化疗临床有效（CR＋PR）患者5年OS为62.5%,明显高于无效患者（41.7%）。pCR患者5年OS为92.9%,未达到pCR患者5年OS为47.9%,2组之间的生存率差异有统计学意义（P〈0.05）。结论：对于可手术切除的晚期舌鳞状细胞癌,诱导化疗联合手术和（或）放疗等综合治疗方案是可行有效的治疗方法。虽然诱导化疗的缓解率有限,但有效缓解与患者较好的预后密切相关,尤其是达到pCR者。

Objective：To discuss the long-term efficency of preoperative induction chemotherapy（IC）± radiotherapy on patients with resectable stage III or IV squamous cell carcinoma of the oral cavity tongue（SCCOT）. Method ： During June 1996 to December 2005, 73 patients with locally advanced SCCOT treated preoperatively with IC（3 cycle of eisplatin and 5-fluorouracil） followed by surgery（resection of the primary tumor and neck）4- radiotherapy in the Cancer Center of Sun Yat-sen University were enrolled in our study. Five-year overall survival rates （OS）, local control rate and reasons of treatment failure were analyzed retrospectively. Result：The follow-up time was 1.9 to 188.0 months, and the median follow-up time was 70.9 months. Among that,24 cases（32.9%） were still alive, of which 23 patients survival time is more than 10 years until the deadline of the follow-up. After IC, 17 patients（23.3%） had clinical complete response; 44 patients（60.3o/oo） had a clinical partial response： 12 patients （16.4 %） had no response or progression, and an overall response rate was 83.6 % （65/73）. On final surgical pathology, 14 patients（19.2O/oo） had pathological complete response; 59 patients（80.8%） had histological incomplete response（residual tumor）. Univariate analysis showed that the tumor size（P〈0.05） , cervical lymphatic metastasis（P〈0.05） ,clinical stage（P〈0. 05） ,the different clinical remissions（P〈0.05 ） , had or not pathological complete remission（P〈0.05） were risk factors affecting prognosis（P〈0.05）. Multivariate analysis indicated that cervical lymphatic metastasis cervical lymphatic metastasis （P〈 0. 05）, the different clinical remissions （P〈0.05）, had or not pathological complete remission（P〈0.05） were independent factors for prognosis. Five-year OS of clinical effective of IC was 62.5%, apparently higher than the invalid effect 41.7% （P〈0.05）. Five-year OS of pCR was 92.9% ,while have no pCR was 47.9% （P〈0.05）. A significant difference between the two groups was also found. During whole follow-up time, 22 patients developed recurrence. Five-year OS was 59.8%, local control rate were 69.9%. Conclusion： IC plus surgery with or without postoperative radiotherapy was a treatment modality that was tolerated with encouraging activity and survival outcome in patients with advanced resectable SCCOT. Response rate with this IC regimen was limited, but the responders were associated with excellent prognosis.