65岁以上老年下咽癌患者生存因素分析

Predictive factors of survival in the elderly patients aged over 65 years old with hypopharyngeal carcinoma

目的分析影响老年下咽癌患者生存的因素,为老年下咽癌患者选择最佳治疗方法提供依据。方法回顾性分析2015年2月至2018年8月在郑州大学附属肿瘤医院就诊并经病理学证实为下咽鳞癌的90例老年患者(≥65岁)的临床资料,并分析患者总生存和疾病无进展生存影响因素。结果90例患者的1、3和5 a总生存率分别为88.9%、52.2%和30.0%,疾病无进展生存率分别为63.3%、21.1%和5.6%。单因素分析结果显示患者总生存与基础疾病、T分期、N分期、体质量指数、治疗方式和KPS评分有关(χ^(2)=6.156,P=0.013;χ^(2)=15.453,P=0.001;χ^(2)=14.784,P=0.002;χ^(2)=4.565,P=0.033;χ^(2)=6.670,P=0.034;χ^(2)=20.433,P<0.001),疾病无进展生存与基础疾病、T分期、N分期、治疗方式和KPS评分有关(χ^(2)=7.221,P=0.007;χ^(2)=11.104,P=0.011;χ^(2)=29.706,P<0.001;χ^(2)=7.374,P=0.025;χ^(2)=15.094,P<0.001);多因素分析结果显示T分期、N分期、治疗方式和KPS评分是影响总生存的独立因素(HR=2.104,P<0.001;HR=1.960,P<0.001;HR=0.506,P=0.006;HR=4.186,P=0.005);T分期和N分期是影响疾病无进展生存的独立因素(HR=2.058,P=0.001;HR=2.459,P<0.001)。亚组分析显示Ⅱ~Ⅲ期老年下咽癌患者的总生存和疾病无进展生存与治疗方式无关(χ^(2)=1.443,P=0.486;χ^(2)=3.404,P=0.182)。结论T分期、N分期、治疗方式和KPS评分是影响老年下咽癌患者总生存的主要因素,T分期和N分期是影响疾病无进展生存的主要因素,Ⅱ~Ⅲ期老年患者可选择相对安全的单纯放疗或同期放化疗。

Objective To investigate the influencing factors of overall survival and progression-free survival time of elderly patients with hypopharyngeal carcinoma,so as to provide the basis for the selection of the optimal treatment for these patients.Methods The clinical data of 90 elderly patients who were diagnosed for hypopharyngeal squamous cell carcinoma undergoing single-modality treatment from February,2015 to August,2018 in the Affiliated Cancer Hospital of Zhengzhou University were analyzed retrospectively,the influencing factors of overall survival and progression-free survival time were analyzed.Results The 1-year,3-year and 5-year overall survival rate were 88.9%,52.2%and 30.2%,while the progression-free survival rate were 63.3%,21.1%and 5.6%respectively.Univariate analysis showed that the overall survival rate was significantly related with basic disease,T-stage,N-stage,body mass index,treatment strategy and KPS score(χ^(2)=6.156,P=0.013;χ^(2)=15.453,P=0.001;χ^(2)=14.784,P=0.002;χ^(2)=4.565,P=0.033;χ^(2)=6.670,P=0.034;χ^(2)=20.433,P<0.001);while the progression-free survival rate was significantly related basic disease,treatment strategy,T-stage,N-stage and KPS score(χ^(2)=7.221,P=0.007;χ^(2)=11.104,P=0.011;χ^(2)=29.706,P<0.001;χ^(2)=7.374,P=0.025;χ^(2)=15.094,P<0.001).Multivariate analysis of Cox regression model showed T-stage,N-stage,treatment strategy and KPS score were statistically significant influencing factors of overall survival rate for elderly patients with hypopharyngeal carcinoma(HR=2.104,P<0.001;HR=1.960,P<0.001;HR=0.506,P=0.006;HR=4.186,P=0.005);while T-stage and N-stage were independent influencing factors of progression-free survival rate for elderly patients with hypopharyngeal carcinoma(HR=2.058,P=0.001;HR=2.459,P<0.001).Subgroup analysis showed that the overall survival and disease progression free survival of stageⅡ-Ⅲelderly patients with hypopharyngeal carcinoma were not related to treatment strategy(χ^(2)=1.443,P=0.486;χ^(2)=3.404,P=0.182).Conclusion T-stage,N-stage,treatment strategy and KPS score were the main factors influencing overall survival rate on elderly patients with hypopharyngeal carcinoma;T-stage and N-stage were the main factors influencing progression-free survival rate.Elderly patients with stageⅡ-Ⅲcan choose radiotherapy alone or concurrent chemoradiotherapy as a relatively safe treatment.