计划性颈淋巴清扫术在局部晚期头颈部鳞状细胞癌综合治疗中的应用

Planned neck dissection in the treatment of locally advanced head and neck squamous cell carcinoma

目的评价计划性颈淋巴清扫术联合诱导化疗＋同步放化疗对于改善局部晚期头颈部鳞状细胞癌颈部淋巴结控制率以及总体预后的价值。方法针对1Va～IVb期并且颈部淋巴结分期为N2～N3的头颈部（包括口咽、下咽、喉）黏膜鳞状细胞癌患者的前瞻性随机对照研究，共纳入64例患者，均经过头颈肿瘤多学科协作团队讨论，认为符合人组条件者方可进人该项研究。人组患者均接受2-3次诱导化疗，根据疗效评估，将原发灶完全缓解或接近完全缓解、颈部淋巴结部分缓解或病情稳定的患者按照数字随机法以1：2的比例分人研究组（计划性颈淋巴清扫术＋同步放化疗）和对照组（同步放化疗），比较两组患者之间临床病理参数、原发部位复发、颈部淋巴结复发、无病生存以及总生存的差异。采用SPSS19．0统计软件对所有数据进行统计学分析。结果研究组共人组21例患者，对照组共人组43例患者，所有人组患者的随访时间为4-55个月，中位随访时间22个月。研究组患者的2年总生存率为80．9％，2年无瘤生存率为68．3％。对照组患者的2年总生存率为90．7％，2年无瘤生存率为67．1％。两组患者在性别（P=0．215）、年龄（P=0．828）、肿瘤部位（P=0．927）、原发部位复发（P=0．126）、无瘤生存率（P=0．710）、总生存率（P=0．402）等方面差异无统计学意义，而在颈部淋巴结复发（X。=5．640，P〈0．05）、远处转移（X^2=10．363，P〈0．01）等方面差异有统计学意义。结论诱导化疗＋计划性颈淋巴清扫术＋同步放化疗的综合治疗模式对提高局部晚期头颈部鳞癌颈部控制率有积极的意义。

Objective To investigate the value of planned neck dissection combined with induction chemotherapy and concurrent chemoradiotherapy in regional control and the outcome of locally advanced head and neck squamous cell carcinoma. Methods A prospective randomized controlled study totally enrolled sixty-four patients of head and neck squamous cell carcinomas （include oropharynx, hypopharynx, and larynx） in stages IVa - lVb with lymph node metastase was were N2 - N3. All patients firstly received 2 - 3 cycles of induction chemotherapy（ ICT）, then divided into two groups randomly, according to the efficacy of ICT. Group A （the study group ） received planned neck dissection （PND） and concurrent chemoradiotherapy（CCRT）. Group B （the control group） received concurrent chemoradiotherapy（CCRT）. The differences in clinicopathologic features, local recurrence（ LR）, regional recurrence（ RR）, disease-free survival（DFS） , and overall survival（OS） between the two groups were estimated. SPSS 19.0 software was used to analyze the data. Results Group A enrolled twenty-one patients, and group B enrolled forty-three patients. The follow-up of all patients were 4 - 55 months, median follow-up time was 22 months. In study group, two-year OS and DFS were 80.9% and 68.3% , respectively. In control group, two-year OS and DFS were 90.7% and 67.1% , respectively. There was no significant difference in gender（P = 0. 215）, age （P =0. 828）, primary tumor site（P =0. 927）, LR（P =0. 126）, DFS（P --0. 710）, and OS（P=O. 402） between the two groups, while the RR （ X2 = 5. 640, P 〈 0. 05 ） and distant metastasis （ X^2 = 10. 363, P 〈 0. O1 ） showed significant differences between the two groups. Conclusion The ICT ＋ PND ＋ CCRT treatment model has benefit on regional control of locally advanced head and neck squamous cell carcinoma.