局部晚期喉癌手术与非手术综合治疗的远期疗效分析

Analysis of the long-term efficacy between surgical and non-surgical comprehensive therapies for locally advanced laryngeal cancer

目的比较手术与非手术综合治疗对于局部晚期喉癌(T3~4N0~3M0)的远期疗效,探讨晚期喉癌治疗方式的选择。方法回顾分析我院初诊的190例局部晚期喉癌患者经手术[全喉切除(TL)或部分喉切除(PL)]与非手术治疗[放化疗(CRT)或同步放化疗(CCRT)]的临床及随访资料,手术组136例(TL 100例,PL 36例),非手术组54例(CRT 42例,CCRT 12例),分析2组总体及各临床、病理亚组治疗后5年生存结局及生存影响因素。结果手术组与非手术组5年总生存率(OS)分别为50.7%和33.3%(Log-rankχ^2=9.116,P<0.01),5年无进展生存率(PFS)分别为46.3%和22.2%(Log-rankχ^2=13.927,P<0.01)。原发瘤声门上型、T4期、淋巴结转移、临床Ⅳ期喉癌手术组5年OS较高(P<0.01)。非手术组8例T4b期患者5年内全部死亡;46例化疗有效患者5年OS为39.1%,与手术组(50.7%)比较差异无统计学意义(Log-rankχ^2=1.855,P>0.05);11例患者行挽救性TL,5年OS为45.5%,与手术组(50.7%)比较差异无统计学意义(Log-rankχ^2=0.114,P>0.05)。与手术组相比,非手术组患者死亡的风险相对增高(HR=2.580,95%CI:1.665~3.997,P<0.01)。多因素分析显示吸烟、淋巴结转移、临床Ⅳ期、肿瘤复发是影响晚期喉癌OS的独立危险因素(均P<0.05)。结论局部晚期喉癌以手术为基础的综合治疗远期疗效较好;对诱导化疗有效的患者可试行保留喉功能的非手术治疗,治疗失败者行挽救性全喉切除可能改善患者的远期生存。

Objective To compare the long-term efficacy of surgical and non-surgical comprehensive therapies in the treatment of locally advanced laryngeal cancer(T3-4N0-3M0),and to explore the treatment options for the advanced laryngeal cancer.Methods The clinical data and follow-up data of 190 patients initially diagnosed with locally advanced laryngeal cancer and underwent surgical(total laryngectomy or partial laryngectomy,TL/PL)and non-surgical(chemoradiotherapy or concurrent chemoradiotherapy,CRT/CCRT)treatments in our hospital were enrolled in the study for a retrospective analysis.The 5-year survival results and survival influencing factors in two groups as well as clinical and pathological subgroups were explored and discussed.Results There were 136 patients in the surgical group(TL 100 cases,PL 36 cases)and 54 patients in the non-surgical group(CRT 42 cases and CCRT 12 cases),of which the 5-year overall survival(OS)rates were 50.7%and 33.3%in surgical group and non-surgical group respectively(Log-rankχ^2=9.116,P<0.01).The 5-year progressionfree survival(PFS)rates were 46.3%and 22.2%respectively(Log-rankχ^2=13.927,P<0.01).For patients with T4 tumors,clinical stageⅣ,lymph node metastasis and supraglottic laryngeal cancer,the 5-year OS was higher in the surgical group than that in the non-surgical group(P<0.01).In the non-surgical group,8 patients with T4b stage died within 5 years.The 5-year OS of 46 patients who effectively responded to the induction chemotherapy was 39.1%,which was not statistically different from that of the surgical group(50.7%,Log-rankχ^2=1.855,P>0.05).Eleven patients underwent salvage TL with a 5-year OS of 45.5%,which was not statistically different from that of the surgical group(Log-rankχ^2=0.114,P>0.05).Moreover,compared with the surgical group,patients of the non-surgical group showed a higher risk of death(HR=2.580,95%CI:1.665-3.997,P<0.01).Multivariate analysis showed that smoking,lymphatic metastasis,clinical stageⅣand tumor recurrence were independent prognostic factors for OS of advanced laryngeal cancer(P<0.05).Conclusion For locally advanced laryngeal cancer,the long-term efficacy of comprehensive therapy based on surgical treatment is better than that of the non-surgical treatment.Patients who are effective to induction chemotherapy could try non-surgical treatment to preserve laryngeal function.The salvage of total laryngectomy may improve the long-term survival for patients with non-surgical treatment failure.