个体化选择治疗对晚期喉癌患者远期生存率影响的临床研究

The impact of individualized treatment on the long-term survival in patients with advanced laryngeal cancer

目的探讨个体化选择治疗对提高晚期喉癌患者远期生存率的临床价值。方法回顾性收集142例喉癌患者的临床资料,其中早期(Ⅰ~Ⅱ期)喉癌患者54例(38.0%),晚期(Ⅲ~Ⅳ期)喉癌患者88例(62.0%),所有患者接受了同步放化疗、单纯放疗或手术治疗,其中有41例晚期喉癌患者接受了以新辅助化疗诱导的个体化选择治疗。通过生存曲线比较不同分期、不同治疗方式喉癌患者的远期生存率差异,并通过多因素Cox风险分析比较个体化选择治疗与传统治疗对改善晚期喉癌患者远期生存率的差异。结果晚期喉癌患者的5年生存率明显低于早期喉癌患者的5年生存率(67.0%vs 88.9%,P=0.003)。晚期喉癌患者接受个体化选择治疗后的5年生存率与手术治疗相近(78.0%vs 80.0%,P=0.861),但明显高于单纯放疗或同步放化疗组患者的5年生存率(78.0%vs 40.7%,P=0.002)。多因素Cox风险分析证实个体化选择治疗对提高远期生存率的价值优于单纯放疗或同步放化疗(HR:0.44,95%CI:0.27~0.72,P=0.001),同时个体化选择治疗对喉癌患者总体生存率的影响接近于手术治疗的效果(HR:0.74,95%CI:0.38~1.24,P=0.318)。结论以新辅助化疗诱导的个体化选择治疗能够改善晚期喉癌患者的远期生存率。

Objective To investigate the clinical value of individualized treatment for improving the long-term survival in patients with advanced laryngeal cancer. Method 142 cases of patients with laryngeal cancer were retrospectively analyzed, in which 54 cases（38.0%） were diagnosed at early stage, and 88 cases（62.0%） were with advanced diseases,these patients received chemoradiotherapy, radiotherapy only or surgery, and 41 cases of advanced laryngeal cancer were administered with individualized treatment induced by neoadjuvant chemotherapy. Survival curves were plotted to compare the difference of survival rates in patients with different tumor stage or different therapy, and the multivariable Cox proportional hazards analysis was used to compare the differences in survival of patients with advanced laryngeal cancer who were treated with individualized treatment or and those who were administered with traditional treatment. Result The 5-year survival rate of patient with advanced laryngeal cancer was significantly lower than those with early laryngeal cancer（67.0% vs 88.9%, P=0.003）. Of patient with advanced laryngeal cancer, the 5-year survival rate of patients after individualized treatment had similar survival rate with those who received total laryngectomy（78.0% vs 80.0%, P=0.861）,but was significantly higher than the survival rate of patients that received simple chemotherapy or concurrent chemoradiotherpay（78.0% vs 40.7%, P=0.002）. Multivariable Cox analysis showed that the individualized treatment may provide higher improvement in overall survivals compared with chemoradiotherapy or radiotherpay in patient with advanced laryngeal cancer（HR： 0.44, 95%CI： 0.27-0.72, P=0.001）, and was similar to total laryngectomy regarding overall survival（HR： 0.74, 95%CI： 0.38-1.24, P=0.318）. Conclusion The individualized treatment induced by neoadjuvant chemotherapy may improve the long-term survival for patients with advanced laryngeal cancer