晚期下咽癌诱导化疗后血管变化对预后的影响

Effect of vascular changes on prognosis after induced chemotherapy for advanced hypopharyngeal carcinoma

目的分析晚期下咽癌诱导化疗后窄带成像(narrow band imaging,NBI)血管下降型和无下降型患者的临床特征,比较2组患者的生存差异,探讨晚期下咽癌患者诱导化疗后血管变化对临床预后的影响.方法收集2014年8月至2016年9月首都医科大学附属北京同仁医院收治的56例男性晚期下咽癌患者的临床资料,年龄46~77岁,中位年龄59岁.按照诱导化疗后NBI血管分型有无下降分为2组,每组均为28例,回顾性分析2组患者的生存差异,以及不同因素对预后的影响.采用SPSS24.0软件对数据进行分析.频数资料组间比较采用χ^2检验.生存分析采用Kaplan-Meier法及多因素Cox回归分析,组间曲线比较采用Log-Rank检验.结果晚期下咽癌诱导化疗后NBI血管下降型及无下降型患者复发情况存在差异(χ^2=4.978,P=0.026);化疗疗效方面,NBI血管下降型患者中8例完全缓解(CR),20例部分缓解(PR),NBI血管无下降型患者中20例PR,8例疾病稳定(SD),2组差异有统计学意义(χ^2=16.000,P<0.001).多因素分析结果显示,诱导化疗后NBI血管分型变化是影响晚期下咽癌诱导化疗后患者预后的因素.结论诱导化疗后NBI血管分型变化可以作为评价患者预后情况的参考指标,诱导化疗后NBI血管分型下降型患者存在生存获益.

Objective To analyze the clinical characteristics of two groups(vascular classification declines or not in narrow band imaging (NBI) of patients with advanced hypopharyngeal carcinoma after induced chemotherapy, to follow-up and compare the survival differences between the two groups, and to explore the effect of vascular changes on clinical prognosis after induced chemotherapy in patients with advanced hypopharyngeal carcinoma. Methods Clinical data of 56 patients with advanced hypopharyngeal carcinoma from August 2014 to September 2016 in Beijing Tongren Hospital, Capital Medical University were collected. The patients were divided into two groups according to NBI vascular classification declines or not after induced chemotherapy. The survival of patients and the impact of different factors on the prognosis were retrospectively analyzed. SPSS 24.0 statistical software was used for analysis. Frequency data were compared between the two groups using χ^2 test. Kaplan-Meier method and Cox regression analysis were employed for survival analysis and Log-Rank test was used for inter-group comparison, P<0.05 was statistically significant. Results There was significant difference in overall survival rate(OS) between two groups of patients with advanced hypopharyngeal carcinoma after induced chemotherapy (P<0.05). Multivariate analysis showed that NBI vascular classification changes after induced chemotherapy was the impact factor for prognosis of advanced hypopharyngeal carcinoma after induced chemotherapy. Conclusion In addition to recurrence and metastasis, NBI vascular classification changes is the important impact factor for prognosis of advanced hypopharyngeal carcinoma after induced chemotherapy. Patients with NBI vascular classification declines have significant survival benefit. The patients with advanced hypopharyngeal carcinoma should be checked with NBI examination before and after induced chemotherapy. NBI should be included in the routine screening indicators for prognosis of advanced hypopharyngeal carcinoma.