64例下咽癌患者术后生存分析

Analysis of postoperative survival in 64 patients with hypopharyngeal carcinoma

目的分析行开放性手术下咽癌患者生存时间的影响因素。方法回顾性分析2010年12月~2018年12月行开放性手术的64例下咽癌患者临床资料,根据2010AJCC TNM分期:T1期3例(4.7%),T2期11例(17.2%),T3期15例(23.4%),T4期35例(54.7%)。随访所有患者术后生存情况;Kaplan-Meier法进行单因素生存分析并行Log-rank检验,Cox回归模型对生存预后影响因素进行多因素分析。结果64例患者失访3例,随访率95.3%。27例死亡患者中病理淋巴结阳性者23例(85.2%),术后咽瘘者10例(37.0%),淋巴结复发者18例(66.7%);34例存活患者中病理淋巴结阳性者17例(50%),术后咽瘘者6例(17.6%),淋巴结复发者1例(3.0%)。单因素分析显示淋巴结转移、咽瘘及淋巴结复发是影响下咽癌患者术后生存时间的因素差异具有统计学意义(P<0.05);Cox回归模型多因素分析显示术前淋巴结转移及术后放/化疗是影响下咽癌患者术后淋巴结复发的危险因素差异具有统计学意义(P<0.05)。结论下咽癌早期临床症状不明显,发现时多已处于中晚期,预后较差,对影响下咽癌患者术后生存时间因素的淋巴结转移、咽瘘以及淋巴结复发应予以重视,淋巴结转移及术后同步放化疗是淋巴结复发的影响因素。

Objective To analyze the influencing factors of survival time of patients suffering from hypopharyngeal carcinoma treated with open operation.Methods Clinical data of 64 patients with hypopharyngeal carcinoma treated with open operation from Dec 2010 to Dec 2018 were analyzed retrospectively.All the patients had been followed up to assess their survival time.According to the AJCC TNM staging criteria(2010),3 cases were T1(4.7%),11 were T2(17.2%),15 were T3(23.4%)and 35 were T4(54.7%).Univariate survival analysis was performed by Kaplan-Meier method with Log-rank test.Cox regression model was used to analyze the factors influencing survival and prognosis.Results Of the 64 patients,3 were lost to follow-up with a follow-up rate of 95.3%.Among the 27 died patients,23(85.2%)had pathologically positive lymph nodes,10(37.0%)had postoperative pharyngeal fistula,and 18(66.7%)had lymph node recurrence.Of the 34 survivors,the numbers of case with positive lymph nodes,postoperative pharyngeal fistula and lymph node recurrence were 17(50%),6(17.6%)and 1(3.0%)respectively.Univariate analyses showed that lymph node metastasis,pharyngeal fistula and lymph node recurrence were statistically significant influencing factors of the survival time in patients with hypopharyngeal carcinoma(all P<0.05).Multivariate analyses of Cox regression model showed preoperative lymph node metastasis and postoperative chemoradiotherapy were statistically significant influencing factors of postoperative lymph node recurrence(P<0.05).Conclusions The early clinical symptoms of hypopharyngeal carcinoma are not obvious.Most of the confirmed patients are at middle and advanced stages with poor prognosis.As the factors affecting the survival time of patients with hypopharyngeal carcinoma,lymph node metastasis,pharyngeal fistula and lymph node recurrence should be worthy of attention.Lymph node metastasis and postoperative concurrent chemoradiotherapy are the influencing factors of lymph node recurrence.