接受挽救手术治疗下咽鳞状细胞癌患者预后影响因素研究

Clinical prognosis and influencing factors of patients with hypopharyngeal squamous cell carcinoma treated by salvage surgery

目的探讨接受挽救手术治疗下咽鳞状细胞癌患者临床预后及影响因素。方法回顾性纳入2017年1月至2022年1月期间于山西省晋城市第二人民医院接受挽救手术治疗下咽鳞状细胞癌患者共78例,记录术后并发症发生情况,采用logistic回归分析评价患者挽救手术5年后是否生存的影响因素,绘制受试者工作特征(ROC)曲线分析各影响因素对下咽鳞状细胞癌患者挽救手术5年后是否生存的预测价值。结果78例患者挽救手术后并发症发生率为21.79%(17/78),中位总生存时间为20.5个月,术后5年死亡21例。单因素分析结果显示,挽救手术年龄(χ^(2)=30.25,P<0.001)、再发肿瘤位置(χ^(2)=8.72,P=0.013)、手术切缘状态(χ^(2)=6.93,P=0.008)、肿瘤浸润深度(χ^(2)=8.31,P=0.004)及挽救手术后是否接受放(化)疗(χ^(2)=4.24,P=0.040)均与下咽鳞状细胞癌患者挽救手术5年后是否生存有关。多因素分析显示,手术切缘状态(OR=26.26,95%CI为4.58~150.62,P<0.001)、肿瘤浸润深度(OR=14.03,95%CI为3.04~64.70,P<0.001)及挽救手术后是否接受放(化)疗(OR=7.73,95%CI为1.68~35.54,P=0.008)均是下咽鳞状细胞癌患者挽救手术5年后是否生存的独立影响因素。ROC曲线分析显示,手术切缘状态、肿瘤浸润深度及挽救手术后是否接受放(化)疗预测下咽鳞状细胞癌患者挽救手术5年后是否生存的敏感性分别为84.15%、79.60%、76.43%,特异性分别为76.03%、83.51%、69.46%。3个指标联合预测的敏感性和特异性分别为92.74%、77.98%。结论下咽鳞状细胞癌患者挽救手术后整体预后良好;手术切缘阳性,肿瘤侵犯肌肉、骨组织或淋巴结包膜,以及挽救手术后未接受放(化)疗与不良预后密切相关;手术切缘状态、肿瘤侵犯情况及挽救手术后辅助治疗情况联合用于预测患者术后生存获益具有良好效能。

Objective To investigate the clinical prognosis and influencing factors of patients with hypopharyngeal squamous cell carcinoma treated by salvage surgery.Methods A total of 78 patients with hypopharyngeal squamous cell carcinoma underwent salvage surgery in Jincheng Second People's Hospital of Shanxi Province from January 2017 to January 2022 were included retrospectively.Postoperative complications were recorded.Logstic regression analysis was used to evaluate the influencing factors of survival after 5 years of salvage surgery,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of various influencing factors on the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery.Results The incidence of complications after salvage surgery in 78 patients was 21.79%(17/78).The median total survival time was 20.5 months.There were 21 deaths 5 years after operation.Univariate analysis showed that the age of salvage surgery(χ^(2)=30.25,P<0.001),location of recurrent tumor(χ^(2)=8.72,P=0.013),surgical margin status(χ^(2)=6.93,P=0.008),depth of tumor invasion(χ^(2)=8.31,P=0.004)and whether to accept radiotherapy(chemotherapy)after salvage operation(χ^(2)=4.24,P=0.040)were all related to the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery.Multivariate analysis showed that the status of the surgical margin(OR=26.26,95%CI:4.58-150.62,P<0.001),the depth of tumor invasion(OR=14.03,95%CI:3.04-64.70,P<0.001)and whether to accept radiotherapy(chemotherapy)after the salvage surgery(OR=7.73,95%CI:1.68-35.54,P=0.008)were independent factors affecting the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery.The ROC curve analysis showed that the sensitivity of surgical margin status,tumor invasion depth and whether to accept radiotherapy(chemotherapy)after salvage surgery to predict the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery were 84.15%,79.60% and 76.43% respectively,and the specificity were 76.03%,83.51% and 69.46% respectively.The sensitivity and specificity of combined prediction of the three indicators were 92.74% and 77.98% respectively.Conclusion The overall prognosis of hypopharyngeal squanous cell carcinoma patients after salvage surgery is satisfactory.Positive surgical margin,tumor invasion of muscle,bone tissue or lymph node capsule,and no radiotherapy or chemical therapy after salvage surgery are closely related to poor prognosis.Meanwhile,the combination of surgical margin status,tumor invasion and adjuvant treatment after salvage surgery has good efficacy in predicting postoperative survival benefit of patients.