天津医药

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声门上型喉癌术前辅助化疗的临床探讨

张强1,张仑1,张文超2,3,姚晓峰2,4,张浏阳1,2,徐本义1,2   

  1. 1. 天津医科大学附属肿瘤医院
    2.
    3. 天津医科大学附属肿瘤医头颈一科
    4. 天津医科大学附属肿瘤医院头颈一科
  • 收稿日期:2010-10-14 修回日期:2011-01-11 出版日期:2011-05-15 发布日期:2011-05-15
  • 通讯作者: 张仑

Clinical Research on Neoadjuvant Chemotherapy in the Treatment of Supraglottic Carcinoma

  • Received:2010-10-14 Revised:2011-01-11 Published:2011-05-15 Online:2011-05-15

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摘要： 摘要 目的 探讨术前辅助化疗在声门上型喉癌的治疗中对手术切除率 、淋巴结转移率、患者生存质量和预后的影响。方法 对1995年5月～2005年12月收治的104例声门上型喉癌行回顾性分析，按2002AJCC分期：临床Ⅰ期7例，Ⅱ期30例，Ⅲ41例，Ⅳ26例， 63例术前予化疗（Ⅰ期5例，Ⅱ期18例，Ⅲ24例，Ⅳ16例）。化疗前后行纤维喉镜及CT检查，化疗后一周行手术。生存分析采用Kaplan-Meier法，各因素间比较用Log-rank检验，多因素分析采用Cox模型。结果：行术前化疗的患者，经喉镜、CT、术中评估及术后病理证实，完全化解者（CR）7.93％(5／63)，部分缓解者（PR）44.44％(28／63)，总有效率(CR+PR) 52.37％，用Log-rank法比较术前化疗组与非化疗组生存期，术前辅助化疗对远期生存有统计学意义(P =0.03)，多因素Cox模型分析表明：N分期，pTNM组织病理学分级与复发是影响生存的独立危险因素（P 均<0.05）。术前诱导化疗是生存的保护性因素（P <0.05）。结论：声门上型喉癌的预后与T分期、N分期、pTNM组织病理学分级、术前化疗及复发等多因素相关。术前辅助化疗，可以提高患者生存率，提高手术切除率，改善预后。

关键词: 喉肿瘤, 鳞状细胞癌, 诱导性化疗, 预后因素

Abstract: Abstract objectives： We talk about the role of neoadjuvant chemotherapy in the treatment of subglottic carcinoma on clinical and pathological features , surgical resection rate, survival rate, lymph node metastasis rate, quality of life and the clinical progonosis. Methods：Clinical data of 104 patients of supraglottic laryngeal carcinoma were analyzed retrospectively from 1995.5 to 2005.12. According to the classification system of AJCC 2002，the case numbers of stage I，II，III and IV were 7，30，41 and 26. 63 patients with neoadjuvant chemotherapy, the case numbers of stage I，II，III and IV were 5，18，24 and 16. Fiber laryngoscope line and CT examination should be taken before and after chemotherapy, underwent surgery a weak later. Survival analysis was performed by Kaplan-Meier method．The factors were compared using the log-rank test．The influencing factors were screened by Cox proportional hazards model. Results:In patients with tumor, confirmed by laryngoscopy and CT,Intraoperative assessment and pathological, completely remission(CR)7.93% (5/63), partial remission(PR)44.44% (28/63),the total effective rate(CR+PR) 52.37%.Log-rank approach was applied to compare the survival time of the preoperative chemotherapy group and non-chemotherapy group, inductes that chemotherapy on long-term survival is significant (P = 0.03), Cox model analysis shows that: N stage, pTNM histopathologic grade and relapse is an independent risk factor affecting survival (P all <0.05). , Neoadjuvant chemotherapy is protective factors （P <0.05）. Conclusion: The prognosis of supraglottic cancer is related to T stage, N stage, pTNM pathological classification, preoperative chemotherapy and relapse etc. Preoperative chemotherapy can improve survival rate, improve the resection rate and the prognosis of patients.

Key words: laryngeal neoplasms, squamous cell carcinoma, neoadjuvant chemotherapy, prognostic factor