124例下咽癌患者甲状腺受侵及中央区淋巴结转移情况的回顾性研究

Retrospective study of thyroid invasion and central lymph node metastasis in 124 patients with hypopharyngeal carcinoma

目的分析下咽癌侵袭甲状腺及中央区淋巴结转移的特点,探讨其对患者生存率及生存质量的影响。方法回顾性分析2014年1月至2017年12月首都医科大学附属北京同仁医院耳鼻咽喉头颈外科初治的124例下咽鳞状细胞癌患者的病例资料,其中男性122例,女性2例,年龄36~78岁。采集资料包括:肿瘤部位、病理T分期、病理N分期、甲状腺受侵情况、中央区淋巴结转移及手术术式等。根据甲状腺是否受侵及中央区淋巴结是否转移分组。随访入组患者的生存状态及肿瘤复发转移等情况,生存分析采用Kaplan-Meier法。结果124例中经病理证实12例患者有甲状腺受侵,5例患者的中央区淋巴结有转移。不同肿瘤原发部位甲状腺受侵的比例为:梨状窝8.16%(8/98),咽后壁1/18,环后3/8,差异有统计学意义(χ^(2)=15.076,P=0.008);中央区淋巴结转移比例为:梨状窝1.02%(1/98),咽后壁3/18,环后1/8,差异有统计学意义(χ^(2)=11.205,P=0.008)。是否有甲状腺受侵或者中央区淋巴结转移与性别、烟酒暴露史、肿瘤病理分化程度等差异无统计学意义(P值均>0.05)。3年总生存(overall survival,OS)率为80.65%,3年无复发生存(relapse-free survival,RFS)率为85.48%。3年总死亡人数为24例,其中甲状腺受侵组4例,中央区淋巴结转移组1例。3年总复发人数18例,均为局部复发,其中甲状腺受侵组4例,中央区淋巴结转移组1例。与是否有甲状腺受侵及中央区淋巴结转移间生存分析差异无统计学意义(P值均>0.05)。不同T分期、N分期、病理分期及分化程度组间的3年OS率及RFS率差异有统计学意义(P值均<0.05)。是否有甲状腺受侵和中央区淋巴结转移组间钙离子及游离三碘甲状腺原氨酸(FT3)水平差异有统计学意义(P值均<0.05)。结论下咽癌侵及甲状腺及中央区淋巴结转移比率不高,发生危险度与肿瘤原发部位相关,对其综合评估、正确决策、精确实施治疗,才能在根治肿瘤、预防复发的同时,提高患者治疗后的生存质量。

Objective To investigate the characteristics of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma,and the impact on survival rate and quality of life.Methods A retrospective analysis of 124 cases(122 males and 2 females with age range from 36 to 78 years old)with laryngopharyngeal squamous cell carcinoma who were initially treated in the Department of Head and Neck Surgery,Beijing Tongren Hospital Affiliated to Capital Medical University from January 2014 to December 2017 was performed.The clinical data included tumor location,pathological T stage,pathological N stage,invasion of thyroid gland,central lymph node metastasis,surgical procedures and so on.Patients were grouped according to if presence of thyroid invasion and central lymph node metastasis.With follow-up,the survival was analyzed by Kaplan-Meier method,and tumor recurrence and metastasis were evaluated.Results Of the patients,12 patients had thyroid involvement and 5 patients had central lymph node metastasis.The incidence of thyroid involvement was 8.16%(8/98)in pyriform sinus,1/18 in posterior pharyngeal wall and 3/8 in posterior cricoid wall,with statistically significant difference(χ^(2)=15.076,P=0.008).The incidence of central lymph node metastasis was 1.02%(1/98)in pyriform sinus,3/18 in posterior pharyngeal wall and 1/8 in posterior cricoid wall,also with statistically significant difference(χ^(2)=11.205,P=0.008).There was no statistical correlation between thyroid invasion or central lymph node metastasis and gender,smoking or alcohol exposure history and tumor pathological differentiation(all P>0.05).The 3-year overall survival rate was 80.65%and the 3-year recurrence free rate was 85.48%.Totally 24 patients died in 3 years,including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group.Local recurrence occurred in 18 patients,including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group.There was no significant difference in survival between patients with and without thyroid invasion and central lymph node metastasis(all P>0.05).There were significantly difference in 3-year overall survival and relapse-free survival among the groups with different T stages,N stages,pathological stages and tumor pathological differentiation levels(all P<0.05).There were significantly differences in the levels of serum calcium and FT3 between the groups with or without thyroid invasion and central lymph node metastasis(all P<0.05).Conclusion The incidences of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma are rare,and the risk of occurrence is related to the primary site of tumor.Comprehensive evaluation,correct decision-making and accurate treatment could be helpful to cure radically the tumor,to prevent recurrence and to improve the quality of life of patients.