局部晚期喉癌患者术后放疗时间对预后的影响及多因素分析

Influence of postoperative radiotherapy time on prognosis in patients with locally advanced laryngeal cancer and multivariate analysis

目的分析影响接受手术+术后辅助放疗的局部晚期喉癌患者预后的因素并评估放疗时间因素对总生存时间的影响。方法回顾性分析2003年1月~2013年12月在中山大学肿瘤防治中心和广东省第二人民医院接受手术+辅助放疗的105例晚期喉癌患者的临床病理资料。总生存率采Kaplan-Meier和Logrank法检验组间差异,采用Cox比例多因素分析风险模型。结果全组中随访期在3、5和10年总生存率分别为68.6%、56.9%和47.7%。单因素分析显示N分期(P=0.001)、切缘(P=0.007)和肿瘤局部处理情况(P=0.008)对患者预后的影响有统计学意义,颈部淋巴结清扫情况(P=0.087)、放疗中断时间(P=0.063)对患者预后的影响接近有统计学意义。多因素分析显示N分期(P=0.004)和切缘(P=0.002)是影响患者预后的独立因素。结论 N分期和切缘是影响患者总生存时间的独立预后因素。保证放疗如期完成是改善这部分患者预后的有效方法。

Objective To analyze the prognostic factors of locally advanced laryngeal cancer after surgery plus adjuvant radiotherapy, and to evaluate the effect of radiotherapy time on total survival time. Methods The clinical and pathological data of 105 patients with advanced laryngeal carcinoma who were treated with surgery and adjuvant radiotherapy at the cancer prevention and treatment center of Zhongshan University and Guangdong No.2 People＇ s Hospital from January 2003, December 2013 were analyzed retrospectively. The overall survival rate was examined by Kaplan-Meier and Log-rank methods, and the risk model was analyzed by Cox proportional multiple factor. Results The overall survival rates at 3, 5 and 10 years were 68.6%, 56.9%, and 47.7%, respectively. Univariate analysis showed that N staging （P=0.001）, margins of resection （P=0.007） and local tumor processing （P=0.008） had statistically significant effects on the prognosis of the patients. The effect of neck lymph node dissection （P=0.087） and radiation interruption time （P=0.063） on the prognosis of the patients was not statistically significant. Multivariate analysis showed that N stage （P=-O.004） and incisal margin （P=0.002） were independent prognostic factors. Conclusion N staging and resection margins are independent prognostic factors affecting overall survival. Ensuring the completion of radiotherapy is an effective method to improve the prognosis of these patients.