333例声门型喉癌颈淋巴结转移与预后的关系

背景与目的:声门型喉癌颈淋巴结转移率不高,颈部处理尚无统一认识.本研究探讨声门型喉癌颈淋巴结转移的预后及其影响因素.方法:收集1992年1月1日至2000年12月31日中山大学肿瘤防治中心收治的333例声门型喉癌患者的临床资料,对颈淋巴结转移情况、预后及颈部处理进行回顾性分析.结果:全组患者总的颈淋巴结转移率9.61%(32/333),隐性淋巴结转移率6.23%(20/321).绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区(28/32).病理分化级别与总的淋巴结转移率(P=0.092)及隐性淋巴结转移率(P=0.067)无明显相关性.总的淋巴结转移率(P=0.002)及隐性淋巴结转移率(P=0.015)随T分期升高而增高.cN0患者颈选择性放疗对隐性淋巴结转移率的影响无显著性(P=0.363).初治cN 组(3、5年生存率分别为56.25%、46;67%)预后差于初治cN0组(3、5年生存率分别为88.70%、85.37%)(P＜0.001);初治cN0组中出现隐性淋巴结转移的预后(3、5年生存率分别为68.18%、63.31%)差于未出现隐性淋巴结转移(3、5年生存率分别为89.00%、85.55%):初治cN 组有淋巴结转移的预后(3、5年生存率分别为41.67%、16.67%)差于初治cNO组中出现隐性淋巴结转移组(3、5年生存率分别为68.18%、63.31%)(P=0.004).结论:声门型喉癌绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区,最多位于同侧Ⅱ区;声门型喉癌颈淋巴结转移影响预后.     

手术切缘对晚期声门型喉癌患者生存预后的影响

目的 探讨手术切缘对晚期声门型喉癌患者生存预后的影响.方法 选择接受手术治疗的140例晚期声门型喉癌患者,根据切缘情况分为阴性切缘与阳性切缘,比较二者局部复发率、区域性转移率;根据切缘范围分为≤3mm、4～5 mm、≥5 mm,比较三者局部复发情况;根据有无局部复发比较3年、5年生存率.结果 140例喉癌患者中28例患者的切缘为阳性,112例切缘阴性.阳性切缘患者中局部复发或淋巴结转移16例(57.14％),阴性切缘患者中局部复发或淋巴结转移19例(16.96％),差异具有统计学意义(P＜0.05).手术切缘≤3 mm的局部复发率为57.14％ (8/14),手术切缘4～5 mm的局部复发率为21.87％ (7/32),手术切缘≥5 mm的局部复发率为l0.64％(10/94),手术切缘≤3 mm的局部复发率显著高于手术切缘4～5 mm与≥≥5 mm的患者,比较差异具有统计学意义(P＜0.05).无局部复发患者3年、5年生存率分别为50.00％、36.61％,显著高于局部复发患者的17.86％、7.14％,比较差异具有统计学意义(P＜0.05).结论 手术切缘与晚期声门型喉癌患者的局部复发率及淋巴结转移率密切相关,切缘阳性患者复发率、转移率较高,预后较差,3年、5年生存率较低.术中可将切缘组织送快速冰冻病理检查,根据检查结果再实施手术,以降低切缘阳性率,减少复发,提高预后生存.     

182例喉癌手术疗效分析

目的:分析影响喉鳞癌的预后因素。方法:男176例,女6例,年龄18岁～78岁,声门上型56例,声门型126例;全喉切除109例,部分喉切除61例,近全喉切除12例;未行颈清术51例,行颈清术131例;单纯手术124例,手术加放疗58例。结果:影响患者生存率的因素有:年龄、喉癌分期、转移淋巴结分期、病理淋巴结转移个数、术后放疗,而喉癌分区、术前呼吸困难、颈部肿块时间不影响生存率。5年生存率为67.58%。结论:中晚期以全喉切除为主,喉部分切除为辅;切缘阳性或淋巴结转移者,需行术后放疗;局部淋巴结复发是喉癌患者死亡的主要原因。     

T3期声门型喉癌的外科治疗选择

目的 探讨T3期声门型喉癌合适的外科治疗方式.方法 回顾性分析57例T3期声门型喉癌患者的临床病理特征、手术方式和预后,分析不同手术方式和不同年龄组患者的3年无瘤生存率.结果 57例T3期声门型喉癌患者全部行喉部手术治疗,失访7例,总的3年无瘤生存率为63.2％(36/57).采用喉全切除术24例,喉近全切除术8例,喉部分切除术25例,3年无瘤生存率分别为66.7％ (16/24)、50.0％ (4/8)和64.0％ (16/25),差异无统计学意义(P =0.694).≥70岁者和＜70岁者的3年无瘤生存率分别为70.0％ (7/10)和61.7％( 29/47),差异亦无统计学意义(P=0.621).36例患者行颈淋巴结清扫术,其中全颈淋巴结清扫2例,改良颈淋巴结清扫6例,分区性颈淋巴结清扫28例,颈部淋巴结转移率为17.5％(10/57).局部复发10例,其中喉部分切除术后7例,喉近全切除术后2例,喉全切除术后1例.结论 喉全切除术与不同的喉部分切除术均是T3期声门型喉癌的重要手术方式,应根据患者局部病变与全身状况的具体情况综合考虑,选择合适的个体化手术方式.≥70岁的T3期声门型喉癌患者,应慎行喉部分切除术,喉全切除术也可以取得满意疗效.     

182例喉癌手术疗效分析

目的：分析影响喉鳞癌的预后因素。方法：男176例，女6例，年龄18岁～78岁，声门上型56例，声门型126例；全喉切除109例，部分喉切除61例，近全喉切除12例；未行颈清术51例，行颈清术131例；单纯手术124例，手术加放疗58例。结果：影响患者生存率的因素有：年龄、喉癌分期、转移淋巴结分期、病理淋巴结转移个数、术后放疗，而喉癌分区、术前呼吸困难、颈部肿块时间不影响生存率。5年生存率为67．58％。结论：中晚期以全喉切除为主，喉部分切除为辅；切缘阳性或淋巴结转移者，需行术后放疗；局部淋巴结复发是喉癌患者死亡的主要原因。     

65例T3声门型喉癌的治疗与预后分析

背景与目的:T3声门型喉癌目前临床治疗上仍有较多争议,本文旨在探讨T3声门型喉癌的不同治疗方案、颈淋巴结转移情况及切缘阳性对预后的影响。方法:回顾性研究1990年1月1日～1998年12月30日中山大学肿瘤防治中心诊治的T3声门型喉癌65例,比较不同治疗方法、切缘情况、颈淋巴结转移情况对预后的影响。结果:全组总的3、5年生存率为75.47%、65.07%。单纯手术、单纯放疗与手术 辅助放疗三组生存率无差异(P=0.914);部分喉切除术与全喉切除术生存率无差异(P=0.710);切缘阳性患者术后加放疗的生存率与切缘阴性患者无差异(P=0.176)。颈淋巴结转移率18.5%,隐性淋巴结转移率10.8%,淋巴结转移是影响预后的重要因素(P<0.001)。结论:对于T3声门型喉癌,单纯手术、单纯放疗与手术 辅助放疗患者生存率无差异;部分喉切除术患者生存率不比全喉切除术低;淋巴结转移影响预后,对cN0患者颈部主张观察;切缘阳性术后加放疗生存率不降低。     

局部晚期喉鳞癌cN0临床观察

目的：探讨喉癌cN0患者颈部处理的方法，降低颈淋巴结转移癌的复发率。方法：回顾分析87例T3、T4期cNo喉癌患者的临床资料，颈部处理方式为颈改良性清扫术或颈分区清扫术，分析手术组阳性淋巴结的分布情况及病理特点，观察颈清扫术对预后的影响，采用Kaplan—Meier方法计算肿瘤复发及生存趋势。结果：87例颈部淋巴结隐性转移率为36．8％，声门上型喉癌40．4％，声门型喉癌32．5％；淋巴结转移分布为：声门上型喉癌89．5％（17／19）位于Ⅱ和Ⅲ区，声门型喉癌92．3％（12／13）位于Ⅱ和Ⅲ区；5年颈部复发率：隐性淋巴结转移复发率为13．5％，无隐性淋巴结转移复发率6．7％；5年生存率：有淋巴结隐性转移生存率为53．8％，无隐性转移为71．1％。结论：晚期喉癌隐性转移率较高，分区清扫术后，隐性转移复发率与无隐性转移复发率无差别，分区清扫术十分必要，注意双侧Ⅱ、Ⅲ区的淋巴结清扫。     

声门上型喉鳞癌微淋巴管密度检测及其临床意义

背景与目的：肿瘤微淋巴管可能对肿瘤的转移起重要作用。本研究旨在通过检测声门上型喉鳞癌微淋巴管密度（1ymphatic microvessel density,LVD）,了解声门上型喉鳞癌微淋巴管生成与其临床病理因素的关系,评估LVD对判断声门上型喉癌预后的价值。方法：回顾性分析确诊并行原发灶切除的51例声门上型喉鳞癌患者临床病理资料,取原发灶石蜡切片行podoplanin单克隆抗体免疫组化染色,并计数podoplanin染色阳性的LVD,统计分析其与喉鳞癌临床病理因素及预后的关系。结果：51例声门上型喉癌标本LVD均值为3．25±2．37,中位数为3,有颈淋巴结转移组患者LVD较无转移组高,差异具有统计学意义（P=0．009）。总体5年生存率为54．9％,肿瘤低分化、局部晚期、淋巴结转移、临床晚期及LVD高均可使5年生存率下降。Cox回归分析提示肿瘤病理分化、T分期及LVD是声门上型喉鳞癌的独立预后因素。结论：声门上型喉癌LVD与淋巴结转移及预后相关,是声门上型喉癌的独立预后因素。     

T3-T4期声门型喉癌颈淋巴结转移情况及其与预后的关系

背景与目的:声门型喉癌颈淋巴结转移率低,有关报道不多,本研究旨在探讨T3-T4期声门型喉癌颈淋巴结转移的相关因素及其对预后的影响。方法:回顾性分析我院1992～2000年收治T3-T4期声门型喉癌83例的临床资料,对颈淋巴结转移率、转移淋巴结的分布、影响cN0颈部复发的因素(颈部预防性放疗、病理分级及T分期)、淋巴结转移与预后的关系。结果:T3-T4期声门型喉癌,总的颈淋巴结转移率为20.5%,cN0颈部复发率为14.3%。绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区,仅1例位于对侧Ⅱ区。cN0者中,颈部预防性放疗与颈部观察在颈部复发率上无差异(P=0.772);病理分级影响cN0颈部复发率(P=0.028);不同T分期颈部复发率无差异(P=0.217)。cN 患者预后明显差于cN0患者(P<0.001);cN0颈部复发不影响预后(P=0.460)。对T3-T4期声门型喉癌cN 患者采用治疗性颈清扫;对cN0患者颈部可密切观察,待出现淋巴结复发再积极治疗。结论:T3-T4期声门型喉癌主要转移至同侧Ⅱ、Ⅲ、Ⅳ区;病理组织分化级别越差,cN0颈部复发的风险越大;cN0颈部复发与预后无关;对cN0患者颈部可进行密切观察;对出现淋巴结复发者应积极治疗。     

声门下型喉癌10例临床回顾性分析并文献复习

背景与目的:声门下型喉癌发病率低,且解剖部位隐匿,故极易漏诊、误诊,确诊时常为临床晚期;因缺乏大宗病例对照研究,其治疗方法目前尚存在争议.本研究旨在探讨声门下型喉癌的临床特征、治疗方法及疗效.方法:回顾分析1981年1月至2005年10月中山大学肿瘤防治中心收治的10例声门下型喉癌患者临床资料.结果:10例中4例喉内侵犯超过半周,4例侵犯喉外器官,1例颈部淋巴结转移;随访15年,1例失访.总的5年生存率为55.5%(5/9),经过治疗5年生存率提高至71.4%(5/7),5年无瘤生存率为42.9%(3/7).行单纯放疗、单纯手术、手术 辅助放疗患者的5年无瘤生存分别为0/2、1/2和2/3.结论:声门下型喉癌早期诊断困难,易在喉内扩散及向周围器官浸润,预后较差.全喉切除术仍为主要手术方式,采用手术与放疗综合治疗疗效满意.     

Poorly differentiated medullary carcinoma of the stomach.

BACKGROUND. The biologic behavior of poorly differentiated medullary carcinoma of the stomach is unclear. METHODS. A clinicopathologic study on 74 poorly differentiated medullary carcinomas (PMC) and 73 nonmedullary carcinomas (NMC) of the stomach was done. PMC were defined as gastric carcinomas in which more than 50% of the tumor area contained poorly differentiated adenocarcinoma with no fibrous stroma. RESULTS. They were characterized by a location in the upper 33% of the stomach (49%), grossly expansive growth (69%), frequent vascular permeation (57%), and simultaneous liver metastasis (15%). Although the 5-year survival rate was similar for PMC and NMC, death of PMC was related more frequently to liver metastasis (47%) and less frequently to peritoneal dissemination (12%). The outcome of patients with PMC was influenced by frequent vascular permeation, extended lymph node metastasis, and simultaneous liver metastasis. CONCLUSIONS. These results indicate that PMC are characterized by expansive growth of the tumor and simultaneous or recurrent metastasis to the liver. Therefore, the biologic behavior of poorly differentiated medullary carcinoma is similar to that of well-differentiated carcinoma of the stomach.     

Cancer of the Nasal Cavity and Paranasal Sinuses: Prognosis and Outcome of Treatment

A retrospective study of 121 patients, 77 men and 44 women, with sino-nasal cancer, admitted to the National University Hospital, Rigshospitalet, during the period 1983-1993, is presented. The median follow-up time was 21 months, (range 3-124). Forty-six percent of the tumors originated from the nasal cavity, 29% from the maxillary sinuses and 5% from the ethmoid sinuses. In 18% of the cases, the site of origin was not clear due to advanced local growth. Sixty-five patients received primary radiation therapy with curative intention of whom 5 underwent secondary surgery. Forty-nine patients underwent primary surgery, 38 of them received postoperative radiation therapy. The overall 5-year survival rate in this material was 35% and the disease-specific 5-year survival was 45%. Patients with well-differentiated squamous cell carcinomas had a significantly higher 5-year survival rate than patients with poorly differentiated carcinomas and patients with regional metastases had a significantly poorer 5-year survival than patients without. The 5-year local control was 48% (41/121). Six of 9 patients with regional metastases at admission were controlled locally, whereas 16 patients developed regional metastases after primary treatment.     

原发灶不明颈淋巴结转移癌42例临床分析

目的探讨原发灶不明颈淋巴结转移癌的诊断、治疗方法与预后的影响因素。方法回顾分析我院1992年2月～1999年2月收治的42例原发灶不明颈淋巴结转移癌患者的临床资料。结果全组的1、3、5年生存率分别为71．4％(30／42)，45．2％(19／42)，33．3％(14／42．)。随诊中有14．3％(6／42．)的原发灶不明颈淋巴结转移癌患者发现了原发灶。结论影响原发灶不明颈淋巴结转移癌预后的主要因素是组织学类型，N分期，转移癌的部位，原发灶是否找到。对颈部转移性低分化癌、未分化癌或鳞癌应采用放射治疗，位于中上颈者应采用面颈联合野放射治疗，转移性腺癌应以手术治疗为主，晚期颈转移癌应采用化疗、放疗为主的综合治疗。锁骨上区转移癌应以化疗为首选。     

Recurrence after radiotherapy for glottic carcinoma

A series of 478 patients with T1-3N0 glottic carcinoma treated by irradiation is presented. Of these patients, 320 were previously untreated, whereas 158 patients were referred for treatment of a recurrence after receiving radiotherapy elsewhere. The primary recurrence rate in the previously untreated patients was 10%. The rate was higher in T2 and T3 tumors, poorly differentiated tumors, and in patients who were in poor general condition. Over 80% of the recurrent tumors were Stage pT3 or pT4, whereas 12% of total laryngectomy specimens showed necrosis only with no evidence of tumor. The necrosis rate in previously untreated patients was 1% for T1 tumors, 4% for T2 tumors, and 3% for T3 tumors. Of all tumors, 60% were transglottic when they recurred, whereas only 29% were confined to the glottis at recurrence. Histologic diagnosis had a high sensitivity but a low specificity, indicating that a negative histologic report is unreliable. Of patients with a recurrent primary tumor, 13% were untreatable. The 5-year survival after a primary recurrence was 39%, and the main prognostic factors were sex, T stage at recurrence, and time to recurrence. Of patients available for follow-up at 5 years 49% were alive with a larynx, 5% were alive without a larynx, 13% were dead of the original cancer, and 33% had died of other causes. In those suffering a primary recurrence, the commonest cause of death was a subsequent lymph node metastasis, followed in order of frequency by stomal recurrence and recurrence in the pharyngeal remnant. The hospital mortality rate after laryngectomy was 3%, and 30% of patients undergoing laryngectomy developed a pharyngocutaneous fistula. The recurrence rate in lymph nodes was 14% at 5 years, general condition and T stage being the only significant predictors of recurrence. Only 17% of patients had small (N1) nodes by the time the diagnosis of cervical lymph node recurrence was made, and 27% of all patients were unsuitable for treatment. Host, tumor factors, and time to recurrence were not significant predictors of survival after node recurrence. The survival rate 5 years after node recurrence was 16%, and the main cause of death in those who died was uncontrolled disease in the neck. The hospital mortality after salvage neck dissection was 4.7%.     

Surgical salvage for recurrent “early” glottic cancers

A 25-year retrospective study of 143 early (T1 and T2 NO) glottic cancer patients was done to determine the recurrence rate following initial radiation therapy, the surgical salvage rate, and incidence of cervical lymph node metastases. Radiation therapy gave a 5-year cure rate of 78% for stage I and 57% for stage II. Total laryngectomy for recurrent squamous cell carcinoma had a 5-year salvage rate of 66% for stage I and 61 % for stage II recurrent tumors. The overall 5-year cure rate with initial and second therapy for stage I and stage II glottic cancers was 93% and 83%, respectively.     

垂直喉部分切除肌皮瓣喉功能重建术

目的：评价垂直喉部分切除肌皮瓣喉功能重建术治疗声门癌效果。方法：对３２例声门癌患分别行垂直半喉及扩大垂直半喉切除,应用颈部带蒂肌皮瓣行喉功能重建。结果：３２例患全部恢复吞咽及发音功能,拨管率为９３．７％,３年和５年生存率分别为９６．６％和８４％,局部复发率为１２．５％。结论：垂直喉部分切除肌皮瓣喉功能重建术扩大了垂直喉部分切除的适应证,提高了术后生存质量。     

宫颈癌骨转移48例临床分析

目的：探讨宫颈癌骨转移的临床特征、危险因素和预后。方法：回顾性分析2000年1月至2010年12月云南省肿瘤医院收治的3642例宫颈癌中发生骨转移的48例患者的临床病理资料。结果：宫颈癌诊断后发生骨转移的时间一般在3年内。低分化患者中,平均发生骨转移时间为6.3个月;中-高分化患者,平均发生骨转移时间为23.8个月。骨盆转移35例,腰椎转移28例,肋骨转移6例;单一部位骨转移14例,两处及以上部位骨转移34例。宫颈癌骨转移的发生率为1.32%（48/3642）,其中宫颈腺癌29例、宫颈鳞癌19例。48例发生骨转移的患者中,2例未接受任何治疗或只接受了对症支持治疗,均在6个月内死亡;其他46例患者接受了手术治疗或放、化疗,目前存活2例（生存时间分别为14、26个月）。结论：宫颈癌骨转移一般在诊断后3年内发生,以骨盆和椎骨为主要转移部位,低分化为发生骨转移的危险因素。宫颈癌发生骨转移者预后不良,积极治疗骨转移可以在一定程度上延长患者的生存时间。     

Management of T1-T2 glottic carcinomas

T1-T2 glottic carcinomas may be treated with conservative surgery or radiotherapy. The goals of treatment are cure and laryngeal voice preservation. The aim of the current study was to review the pertinent literature and discuss the optimal management of early-stage laryngeal carcinoma. Literature review indicated that the local control, laryngeal preservation, and survival rates of patients were similar after transoral laser resection, open partial laryngectomy, and radiotherapy. Voice quality depended on the extent of resection for patients undergoing surgery; results for patients undergoing laser resection for limited lesions were comparable to the corresponding results for patients receiving radiotherapy, whereas open partial laryngectomy yielded poorer results. Costs were similar for laser resection and radiotherapy, but open partial laryngectomy was more expensive. Patients with well defined lesions suitable for transoral laser excision with a good functional outcome were treated with either laser or radiotherapy. The remaining patients were optimally treated with radiotherapy. Open partial laryngectomy was reserved for patients with locally recurrent tumors.     

Results of radiotherapy in carcinoma of the larynx

Long-termed treatment results have been analysed in 224 previously untreated patients with a squamous cell carcinoma of the larynx who were given irradiation for curative therapy. The 5-year cumulative local control rates of T1NO and T2NO cases with phonation were 80.9% and 74.1%, respectively and a total laryngectomy was chiefly performed for the recurrent cases. The 5-year cumulative local control rates with of without phonation were 97.0% and 91.8%, respectively. The introduction of a multi-disciplinary treatment was found necessary for the locally advanced cases (T4 or N3 cases), because of a low local control rate (about 25%) from radiotherapy alone.