小剂量顺铂化疗联合喉部分切除术治疗喉癌效果分析及对患者甲状腺功能的影响

Effect of low-dose cisplatin chemotherapy combined with partial laryngectomy on laryngeal carcinoma and its influence on thyroid function

目的探讨小剂量顺铂化疗联合喉部分切除术治疗喉癌的疗效分析及对患者甲状腺功能的影响。方法回顾性分析2012年1月至2013年5月解放军联勤保障部队第九○八医院和江西省肿瘤医院收治的喉癌患者102例的临床资料,根据治疗方法不同,将患者分成对照组51例(应用喉部分切除术治疗)、喉切除联合化疗组51例[喉部分切除联合应用小剂量(50mg/m2)顺铂化疗]。观察对比2组喉癌患者的疾病控制率及缓解率、5年生存率、治疗前及治疗后的甲状腺功能变化情况[促甲状腺激素(TSH)、血清总三碘甲腺原氨酸(T3)及血清总四碘甲腺原氨酸(T4)]、治疗后的不良反应发生情况及患者体内肿瘤细胞的凋亡率。结果喉切除联合化疗组患者经治疗后总的疾病控制率为92.2%、疾病缓解率为64.7%,对照组分别为78.4%、47.1%,喉切除联合化疗组患者的临床疗效显著高于对照组(P<0.05)。喉切除联合化疗组患者的5年总生存率为显著高于对照组(86.3%vs56.9%,P<0.05)。治疗后,喉切除联合化疗组患者的TSH水平为(2.61±0.61)nmol/L,显著高于对照组患者的(1.79±0.48)nmol/L(P<0.05);喉切除联合化疗组患者血清T3、T4水平为(4.09±0.44)nmol/L、(16.17±2.27)μIU/L,显著低于对照组患者的(5.46±0.52)nmol/L、(17.68±2.15)μIU/L(P<0.05)。喉切除联合化疗组患者的Ⅲ级及Ⅳ级不良反应发生率显著低于对照组(25.5%vs56.9%,P<0.05)。喉切除联合化疗组患者体内的肿瘤细胞凋亡率显著高于对照组([29.32±2.63)%vs(20.97±1.69)%,P<0.05]。结论对喉癌患者应用小剂量顺铂联合喉部分切除术,能提高患者体内肿瘤细胞的凋亡率,疗效更显著。但须严格监控患者的T3、T4及TSH的指标水平,以免出现全身性代谢减低综合征。

Objective To investigate the efficacy analysis of low-dose cisplatin chemotherapy combined with partial laryngectomy in the treatment of laryngeal cancer and the effect on thyroid function of patients.Methods A retrospective analysis from January 2012 to May 2013,the people's liberation army logistic support forces result 9 and jiangxi province tumor hospital of the clinical data of 102 cases of laryngeal cancer patients admitted in the hospital.According to different treatment methods,the patients were divided into control group(51 cases treated with partial laryngectomy)and laryngectomy combined with chemotherapy group[51 cases treated with partial laryngectomy combined with low dose(50 mg/m2)of cisplatin]..Observed and compared two groups of patients with laryngeal cancer disease control rate and remission rate,5-year survival rate,changes before and after the treatment of thyroid function[thyroid-stimulating hormone(TSH),serum total three iodine armour gland original glycine(T3)and serum total four iodine a gland glycine(T4)],adverse reactions occurred after treatment,and patients with tumor cell apoptosis rate in the body.Results The total disease control rate and remission rate of laryngectomy combined with chemotherapy group were 92.2% and 64.7% respectively.The control group was 78.4% and 47.1% respectively.The clinical efficacy of patients in the laryngectomy combined with chemotherapy group was significantly higher than that in the control group(P<0.05).The 5-year overall survival rate of patients in the laryngectomy combined with chemotherapy group was 86.3%, significantly higher than that of the control group(86.3% vs 56.9%,P<0.05).After treatment,the TSH level in laryngectomy combined with chemotherapy group was(2.61±0.61)nmol/L,significantly higher than control group in patients with TSH level(1.79± 0.48)nmol/L(P<0.05),serum total laryngectomy combined chemotherapy group patients T3 and T4 level(4.09±0.44)nmol/L,(16.17±2.27)μIU/L,The level of T3/T4 was significantly lower than that of control group(5.46±0.52)nmol/L and(17.68±2.15)μIU/ L(P<0.05).Laryngectomy in combination with chemotherapy group Ⅲ level and Ⅳ level in patients with the incidence of adverse reactions was significantly lower than the control group patients Ⅲ level and grade Ⅳ incidence by 56.9%(25.5% vs 56.9%,P<0.05).The apoptosis rate of tumor cells in the laryngectomy combined with chemotherapy group was significantly higher than that in the control group[(29.32±2.63)% vs(20.97±1.69)%,P<0.05].Conclusion Low dose cisplatin combined with partial laryngectomy is more effective in the treatment of laryngeal cancer patients,and can improve the apoptosis rate of tumor cells in patients.However,the index levels of T3,T4 and TSH should be strictly monitored to avoid the occurrence of systemic metabolic reduction syndrome.