术前放化疗后保留喉功能手术梨状窝鳞癌患者的预后

Long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative(chemo-)radiotherapy plus laryngeal function sparing surgery

目的探讨接受计划性术前放疗后留喉手术的梨状窝癌患者的预后。方法回顾性分析1999—2010年中国医学科学院肿瘤医院采用计划性术前放、化疗加手术治疗后,获得喉功能保留的Ⅲ~Ⅳ期梨状窝鳞状细胞癌患者的临床资料,包括是否化疗、术后病理结果、并发症和患者的预后等。单纯放疗20例,同步化疗14例,化疗药物均为单药顺铂,剂量为50 mg/次,1次/周,共5次。结果31例行原发灶手术的患者中,原发灶无肿瘤残留12例(38.7%),重度治疗反应7例(22.5%),肿瘤残留12例(38.7%)。全组患者的5年累积局部复发率为14.5%,颈部复发率为13.7%,远处转移率为23.5%,5年累积总生存率为69.6%,无复发生存率为65.4%。死亡9例,死亡原因包括远处转移8例,颈部复发1例。结论计划性术前放化疗后保留喉功能手术的梨状窝鳞癌患者多数可获得长期生存。远处转移为死亡的主要原因。

Objective To analyze the long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative(chemo-)radiotherapy plus laryngeal function sparing surgery.Methods Patients with stageⅢ/Ⅳpyriform sinus squamous cell carcinoma treated with planned preoperative(chemo-)radiotherapy plus laryngeal function sparing surgery during 1999 to 2000 were retrospectively analyzed.Data including concurrent chemotherapy or not,postoperative pathological diagnosis,postoperative complications,recurrence and survival were collected.Twenty patients were treated with preoperative radiotherapy while 14 patients with preoperative chemo-radiotherapy.Results Among 31 cases of postoperative pathological diagnosed as pyriform sinus,12(38.7%)cases without tumor residue,7(22.5%)cases with severe radiation response and 12(38.7%)cases with tumor residue.The 5-year cumulative local recurrence rate,regional recurrence rate and distant metastasis rate was 14.5%,13.7%and 23.5%,respectively.Five-year cumulative overall survival rate and recurrence-free survival rate were 69.6%and 65.4%,respectively.Nine deaths were attributed to distant metastasis(8 cases)and regional recurrence(1 case).Conclusion Most patients with pyriform sinus squamous cell carcinoma acquire long-term survival after treated with planned preoperative(chemo-)radiotherapy plus laryngeal function sparing surgery,and distant metastasis is the main cause of death.