143例晚期喉癌患者的临床特征及生存分析

目的总结143例晚期喉癌患者的临床特征,分析预后的影响因素。方法回顾性分析2010年1月—2016年12月经中国人民解放军总医院治疗的143例晚期喉癌患者的临床资料。其中,男135例(94.4%),女8例(5.6%);年龄35~79岁,中位年龄58岁。依据患者治疗方案不同分为2组:手术联合术后放化疗组106例和非手术综合治疗组37例。收集患者基本临床情况、治疗、随访及生存情况;生存率及单因素生存分析采用Kaplan-Meier法和log-rank检验,多因素生存分析采用Cox比例风险回归模型。结果143例晚期喉癌患者的5年总体生存率为67.9%。单因素分析显示,影响晚期喉癌患者预后的临床因素有年龄、临床分期、T分期及肿瘤分化程度等(P值均<0.05);Cox模型多因素分析显示,患者年龄、临床分期、肿瘤分化程度及治疗方式是影响预后的独立危险因素(P值均<0.05)。T4期、临床Ⅳ期患者采用手术联合术后放化疗5年生存率分别为62.2%和59.5%,明显好于非手术综合治疗的18.2%和41.4%,差异均有统计学意义(P值均<0.05)。结论晚期喉癌患者预后相对较差,影响患者预后的因素包括患者年龄、临床分期、肿瘤分化程度及治疗方式等。对于临床Ⅳ期、尤其是T4期患者,采取手术联合术后放化疗可以获得相对较好的预后。

Clinical features and prognostic factors of locally advanced laryngeal cancer: an analysis of 143 cases

Objective To summarize the clinicopathological characteristics and prognostic factors of locally advanced laryngeal cancer.Methods The medical records of 143 patients with locally advanced laryngeal cancer who underwent treatment at Chinese PLA General Hospital between January 2010 and December 2016 were reviewed. Among the 143 patients, 135 were males and eight were females. The median age of the whole group was 58 (35-79) years. All patients were divided into two groups: surgery plus radio(chemo)therapy group (106 cases) and non-surgery chemoradiotherapy group (37 cases). The patients' clinical information was collected. Survival rate and univariate survival analyses were performed using the Kaplan-Meier method and the log-rank test, and multivariate survival analysis was calculated using the Cox regression model.Results The 5-year overall survival (OS) rate of patients with locally advanced laryngeal cancer was 67.9%. Univariate analysis results showed that age, tumor differentiation, clinical stage, and T classification significantly affected the prognosis (all P values<0.05). Cox model multivariate analysis showed that age, tumor differentiation, clinical stage, and treatment option were independent risk factors (all P values<0.05). The 5-year OS rates of patients in T₄ stage and clinical stage Ⅳ after the operation combined with postoperative radiotherapy or chemoradiation were 62.2% and 59.5%, respectively, significantly better than those of patients in non-surgical comprehensive treatment (18.2% and 41.4%, respectively, all P values<0.05).Conclusions The OS rates of patients with locally advanced laryngeal cancer were relatively low. Age, clinical stage, tumor differentiation, and treatment option were independent factors affecting the advanced laryngeal cancer prognosis. Combining surgery plus postoperative radiotherapy or chemoradiation provided better survival than non-surgery comprehensive treatment in patients with stage Ⅳ, especially stage T₄ laryngeal cancer.