复发性喉癌患者的临床特点和影响预后因素的分析

Clinical Characteristics and Multivariate Analysis of Prognostic Factors in Recurrent Laryngeal Carcinoma

背景与目的:喉癌复发是影响预后的重要因素,但对复发性喉癌患者的临床特点和影响预后因素的研究较少。本研究的目的是总结分析复发性喉癌患者的临床特点,探讨影响复发性喉癌患者预后的主要因素。方法:回顾性分析1990～1997年80例在中山大学肿瘤防治中心治疗的喉鳞癌复发患者的临床资料,应用Kaplan-Meier法进行生存分析,组间比较用log-rank检验,多因素分析采用Cox模型。结果:复发性喉鳞癌患者的复发部位包括局部复发、颈淋巴结复发及远处转移;本组80例患者总的3年、5年累积生存率分别为50.6%、34.6%;复发后行手术、手术加放疗和手术加化疗者共30例,5年累积生存率为:73.0%;喉鳞癌复发的时间为1～156月,中位时间为11月;复发部位为局部复发36例,颈淋巴结复发36例,4例为同时发生局部和颈淋巴结复发,1例为局部复发伴远处转移,3例为颈淋巴结复发伴远处转移;单因素分析显示:影响复发性喉鳞癌预后的主要因素是:复发部位、复发时间、复发后治疗方式、年龄分组;气管造瘘口周围复发组较喉腔内复发组预后差;颈淋巴结复发组较局部复发组预后差;远处转移组较未发生远处转移组预后差;复发后放疗、化疗组较手术组预后差(P<0.05);多因素分析表明:年龄≥60岁、复发时间<12月、远处转移及复发后行放疗、化疗者预后差(P<0.05)

BACKGROUND &OBJECTIVE: The recurrence is an important factor affecting the prognosis of laryngeal carcinoma. There are few reports on the clinical characteristics and the prognostic factors of recurrent laryngeal carcinoma. The purpose of this study was to analyze the clinical features and prognostic factors of recurrent laryngeal carcinoma. METHODS: The data of 80 patients with recurrent laryngeal carcinoma between 1990 and 1997 were retrospectively investigated. Survival analysis was performed by Kaplan Meier method; comparison among/between groups was performed using log rank test; multivariate analysis was carried out using Cox proportional hazard model. RESULTS: The recurrence sites included locoregional recurrence, neck lymph node and distant metastases. The 3 year and 5 year overall survival rates for patients with recurrent laryngeal carcinoma were 50.6%and 34.6%, respectively. The 5 year disease specific survival rates for the patients treated with surgery, surgery +radiotherapy, and surgery +chemotherapy (30 cases) was 73%. The recurrence of laryngeal carcinoma were developed within 1 156 months, the median time of recurrence was 11 months; there were 36 locoregional recurrence, 36 neck lymph node recurrence, 4 locoregional recurrence associated with neck lymph node recurrence, 1 locoregional recurrence associated with distant metastases, 3 neck lymph node recurrence associated with distant metastases. Univariate analysis revealed that the factors impacting the prognosis were recurrent site, duration of recurrence gaps, treatment modality of recurrence, and age (P< 0.05). The neck lymph node recurrence group, peristomal recurrence group, distant metastases group, radiotherapy and chemotherapy after recurrence group had a poorer prognosis than locoregional recurrence group, laryngx recurrence group, without distant metastases group, and surgery group (P< 0.05). Multivariate analysis showed that age ≥60 years old, duration of recurrence gap < 12 months, distant metastases and radiotherapy or chemotherapy modality after recurrence were independently associated with decreased survival rates (P< 0.05). CONCLUSION: Surgery or surgery dominated multi modality therapy was the principal treatment modality for recurrence laryngeal carcinoma. Age ≥60 years old, duration of recurrence gap < 12 months, distant metastases and salvage therapy by radiotherapy and chemotherapy but not surgery were independent factors affecting the prognosis.