早期喉癌患者的治疗模式及预后分析

Analysis of treatment and prognosis on patients with early laryngeal carcinoma

目的分析早期喉癌患者不同治疗模式的治疗效果和预后因素。方法回顾性分析67例早期喉癌患者的临床资料,单纯手术治疗29例,单纯放疗16例,手术+放疗22例。采用Kaplan-Meier法计算生存率,Log-rank检验进行单因素分析,Cox比例风险模型进行多因素分析。结果单纯手术组、单纯放疗组、手术+放疗组,3年、5年总生存率分别为100%、93.8%、95.5%和96.6%、87.5%、90.9%(P>0.05);3种治疗模式5年局部控制率分别为93.1%、93.8%和100%(P>0.05)。单纯手术组、单纯放疗组、手术+放疗组,喉保留率分别为65.5%、93.8%和100%(P<0.05)。Cox多因素回归分析显示,年龄、T分期是影响早期喉癌患者的不良预后因素。结论早期喉癌采用单纯手术或单纯放疗疗效相当,术后切缘阳性或安全边界不够的患者补充放疗亦可获得较高治愈率,但放射治疗在喉功能保留方面具有明显优势,年龄、T分期是影响早期喉癌患者的不良预后因素。

Objective To compare the outcome of different treatment modalities for early laryngeal carcinoma and to analyze the prognostic factors of these patients. Methods The clinical data of 67 cases with early laryngeal carcinoma were analyzed retrospectively. 29 patients received surgery alone, 16 patients received radiotherapy （RT） alone, and 22 patients received the combination therapy of surgery and RT. The survival rate was calculated by Kaplan - Meier method, Log - rank test was used for univariate analysis and Cox proportional hazards model was used for factor analysis. Results The 3 and 5 year OS of these 67 patients were 100% ,93.8% ,95.5% and 96.6% ,87.5% ,90.9% in surgery group,RT group and the combination group （P 〉0.05）. The 5 years LC rate was 93.1% ,93.8% and 100% for surgery, RT and the combination group （ P 〉 0.05 ）. The final larynx - preservation rate was 65.5% ,93.8% and 100% in surgery, RT and the combination group （P 〈 O. 05）. In Cox regression analysis,age and the T stage was identified as the adverse prognostic factors of the whole group patients. Conclusion Surgery and RT have the same efficacy in treatment of early laryngeal carcinoma, postoperative positive margin or insufficient border security supplemental RT can get higher cure rate, however, RT has advantages in terms of to preserve laryngeal function. Age and T stage are the adverse prognostic factors of these patients.