复发性喉癌患者的临床特点和影响预后因素的分析

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。

Clinical characteristics and multivariate analysis of prognostic factors in recurrent laryngeal carcinoma

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, larynx recurrence group, without distant metastases group, and surgery group (P< 0.05). Multivariate analysis showed that age > or =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 > or =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.