低分化与高分化下咽鳞状细胞癌患者配对生存分析

Paired survival analysis of patients with poorly-differentiated and well-differentiated hypopharyngeal squamous cell carcinoma

目的 分析低分化与高分化下咽鳞状细胞癌(hypopharyngeal squamous cell varcinoma,HPSCC)患者配对资料的临床特征,比较两组患者的生存差异。方法 收集2004年12月~2015年12月首都医科大学附属北京同仁医院47例符合条件的低分化HPSCC患者临床病例资料,根据年龄,性别,分期,治疗方式(手术类型、颈部清扫方式、手术切缘和放化疗),吸烟和饮酒史按1∶1比例与47例高分化HPSCC患者配对。术后至少随访3年。结果 高分化HPSCC患者的3年总生存率(overall survival,OS)为76.6%,无病生存率(disease-free survival,DFS)为78.7%,疾病特异性生存率(disease-specific survival,DSS)为78.7%,均较低分化HPSCC患者高,分别为46.8%、55.3%、51.1%。早期高分化患者生存率最高,晚期低分化患者生存率最低,而晚期高分化患者的生存率较早期低分化和晚期低分化患者生存率高(P<0.01)。晚期低分化患者,术前接受诱导化疗可提高保喉率(P=0.046)。结论 低分化较高分化HPSCC患者预后差,晚期低分化HPSCC患者术前接受诱导化疗可明显提高保喉率。

OBJECTIVE To analyze the clinical characteristics of paired data between patients with poorly-differentiated and well-differentiated hypopharyngeal squamous cell carcinoma(HPSCC),and to compare the survival differences between the two groups.METHODS The clinical data of 47 eligible patients with poorly differentiated HPSCC admitted to Beijing Tongren Hospital of Capital Medical University from December 2004 to December 2015 were collected according to age,sex,stage,treatment mode(surgery type,neck dissection,surgical margin and radiotherapy and chemotherapy),smoking and drinking history were matched with 47 patients with well-differentiated HPSCC at a ratio of 1:1.Followed up for at least 3 years after surgery.RESULTS The 3-year overall survival rate,disease-free survival rate,and disease-specific survival rate of patients with well-differentiated HPSCC were higher than those of patients with poorly differentiated HPSCC(76.6% vs 46.8%;78.7% vs 55.3%;78.7% vs 51.1%).The difference between the two groups was significant.Patients with early TNM stage and well-differentiated HPSCC have the best survival rate,while patients with advanced TNM stage and poorly-differentiated HPSCC have the worst survival rate.Patients with early TNM stage and poorly-differentiated HPSCC have a worse prognosis than patients with advanced TNM stage and well-differentiated HPSCC(P<0.01).The larynx preservation rate was significantly increased in patients with advanced TNM stage(Ⅲ/Ⅳ stage) and poorly-differentiated who underwent induction chemotherapy(P=0.046).CONCLUSION Patients with poorly-differentiated hypopharyngeal squamous cell carcinoma have worse prognosis than patients with well-differentiated HPSCC.Preoperative induction chemotherapy in patients with advanced poorly-differentiated HPSCC can significantly improve the larynx preservation rate and improve the quality of life.