TPF诱导化疗筛选治疗方案在局部中晚期喉癌治疗中的应用

The application of comprehensive treatment based on TPF induction chemotherapy in patients with locally advanced laryngeal cancer

目的研究诱导化疗筛选的综合治疗方案对于局部中晚期喉癌患者生存率及喉功能保留的意义。方法回顾性分析于首都医科大学附属北京同仁医院2013年1月~2019年12月治疗的71例中晚期喉癌患者(T3~T4级病变,评估需全喉切除手术的患者),其中男性69例,女性2例;年龄39~80岁,中位年龄59岁;T3级47例,T4级24例;III期28例,IV期43例;所有患者经MDT讨论后分为两组,其中一组为手术治疗组,另一组为诱导化疗组。比较两组患者的总生存时间(overall survival,OS)、无疾病生存时间(disease free survival,DFS)和喉器官功能保全情况。Kaplan?Meier法绘制生存曲线,采用Log?rank检验,Cox单因素分析对有统计学意义的因素进一步行Cox多因素分析。结果71例患者的随访时间为5~88个月,全部患者的5年OS和DFS分别为63.5%和55.4%。手术治疗组和诱导化疗组患者5年OS分别为62.5%和60.7%(P=0.643),5年DFS分别为57.3%和52.5%(P=0.351)。不同年龄分组和肿瘤分期的患者间比较OS及DFS差异经Log?rank检验有统计学意义(P<0.05)。Cox单因素和多因素分析结果表明年龄和肿瘤分期是影响中晚期喉癌患者预后的独立风险因素(P<0.05)。诱导化疗组患者对诱导化疗的总体敏感率为32.3%,总体喉器官功能保全率为74.2%。结论对于局部晚期需行全喉切除的患者,TPF诱导化疗筛选治疗方案,在不降低生存率情况下可使肿瘤降级,从而明显提高了患者的喉功能保留率,提高患者生存质量。

OBJECTIVE To study the significance of comprehensive treatment based on induction chemotherapy for the survival rate and laryngeal function preservation in patients with locally advanced laryngeal cancer.METHODSThe retrospective analysis included 71 patients who were diagnosed as advanced laryngeal cancer(T3-T4 stage,requiring total laryngectomy)and treated in Beijing Tongren Hospital affiliated to Capital Medical University from January 2013 to December 2019.There were 69 males and 2 females,with a median age of 59 years old(ranged from 39 to 80 years old).For TNM stage,47 cases were diagnosed as T3 stage and 24 cases were T4 stage.For clinical stage,28 cases were diagnosed as stage III and 43 cases were stage IV.All patients were divided into two groups after MDT discussion.The first group was surgery treatment group and the other group was the induction chemotherapy group.The overall survival(OS),disease-free survival(DFS)and laryngeal function preservation rate were compared between the two groups.The Kaplan-Meier method was used to draw the survival curve,and the Log-rank test was used to compare the difference.Univariate and multivariate analyses were performed using a Cox regression model for OS and DFS.RESULTS The follow-up time ranged from 5 to 88 months.The 5-year OS and DFS of all patients were 63.5%and 55.4%respectively.The 5-year OS of patients in the surgery treatment group and induction chemotherapy group were 62.5%and 60.7%respectively(P=0.643),and the 5-year DFS were 57.3%and 52.5%respectively(P=0.351).The differences in OS and DFS between ages≥60 and<60 were statistically significant by Log-rank test(P<0.05),and the differences in OS and DFS between stageⅢandⅣpatients were also statistically significant(P<0.05).COX univariate and multivariate analysis showed that age and tumor stage were independent prognosis factors for OS and DFS in locally advanced laryngeal cancer.The overall sensitivity rate of the induction chemotherapy was 32.3%,and the overall laryngeal function preservation rate reached 74.2%in the induction chemotherapy group.CONCLUSION For locally advanced laryngeal cancer patients who required total laryngectomy,TPF induction chemotherapy help patients choose treatment modality,which could reduce the tumor volume without lowering the survival prognosis,significantly improve the laryngeal function preservation rate and the quality of life.