手术在局部晚期喉咽鳞状细胞癌综合治疗中的应用

Application of surgery in the comprehensive treatment of locally advanced hypopharyngeal squamous cell carcinoma

目的评价手术联合诱导化疗+同步放/化疗对于改善局部晚期喉咽鳞状细胞癌总体预后的价值。方法回顾性分析中山大学肿瘤防治中心2003年6月~2015年12月收治的122例Ⅲ~Ⅳ期喉咽鳞状细胞癌临床资料,入组患者均接受2程诱导化疗,根据后续治疗将患者分为手术组(62例,手术+同步放/化疗)和非手术组(60例,同步放/化疗),比较两组患者的临床病理参数、疗效差异及预后的影响因素。采用SPSS 22.0统计软件对所有数据进行分析。结果入组患者中手术组62例,死亡45例;非手术组60例,死亡38例。单因素分析示:分化程度、肿瘤临床分期Ⅲ/Ⅳ期和是否颈淋巴结转移(P<0.05)是影响患者预后生存的独立因素;多因素分析示:分化程度(P=0.010)、肿瘤临床分期Ⅲ/Ⅳ期(P=0.044)是影响患者预后生存的重要因素。分层分析诱导化疗有效组,手术组患者3年和5年总生存率(overall survival,OS)为93.2%和86.0%,非手术组患者的3年和5年OS分别为74.3%和60.2%,两组之间差异具有统计学意义(χ~2=5.274,P=0.022)。结论对于局部晚期喉咽鳞癌患者,诱导化疗+手术+同步放/化疗的综合治疗模式虽然不能有效提高患者总生存率和无瘤生存率,但对诱导化疗有效者显示了良好的疗效及安全性,可能从手术治疗中获益。

Objective To evaluate the value of primary surgical treatment combined with induction chemotherapy and concurrent chemoradiotherapy in improving the overall prognosis of advanced pharyngeal squamous cell carcinoma.Methods Clinical data of 122 patients with hypopharyngeal quamous cell carcinoma of stagesⅢ~Ⅳhospitalized at the Cancer Center of Sun Yat-Sen University from June 2003 to Dec 2015 were analyzed retrospectively.After 2 cycles of induction chemotherapy,they were divided into surgical treatment group(surgery+chemoradiotherapy)(n=62)and non-surgical treatment group(concurrent chemoradiotherapy)(n=60).The clinicopathological parameters,the differences of the therapeutic effect and prognostic factors between the two groups were compared.Spss22.0 statistical software was used for data analysis.Results Among all the enrolled patients,45 died in 62 of the surgical treatment group and 38 in 60 cases of the non-surgical treatment group.Univariate analyses showed that tumor differentiation,clinical stageⅢ/Ⅳ,and nodal metastasis were independent prognostic factors of hypopharyngeal carcinoma(all P<0.05),and multivariate analyses revealed differentiation(P=0.010)and clinical stageⅢ/Ⅳ(P=0.040)retained significance.Stratified analyses of the effective induction chemotherapy group indicated that the 3-year and 5-year overall survivals(OS)of the surgical treatment group were 93.2%and 86.0%,and those of the non-surgical treatment group were 74.3%and 60.2%.Their differences were statistically significant(P=0.022).Conclusion For locally advanced hypopharyngeal squamous cell carcinoma,primary surgical treatment combined with induction chemotherapy and concurrent chemoradiotherapy can’t effectively improve the OS and disease free survival(DFS)of patients,but those who are effective in induction chemotherapy show good efficacy and safety,and may benefit from surgical treatment.