喉声门上型低分化鳞状细胞癌57例临床观察

目的探讨喉声门上型低分化鳞状细胞癌(简称鳞癌)的临床特点、治疗及预后.方法回顾分析1980～1998年我院57例喉声门上型低分化鳞癌病例(1997年UICC分期Ⅰ期4例,Ⅱ期5例,Ⅲ期18例,Ⅳ期30例).单纯手术25例,单纯放射治疗9例,术前放射治疗加手术14例,手术加术后放射治疗7例,术前化学治疗加手术2例.喉全切除23例,喉部分切除25例;同期颈清扫3l例(单侧17例,双侧14例),上颈清扫12例.结果5年生存率47.4%(27/57),颈部转移率63.2%(36/57),双颈转移率24.6%(14/57),远处转移率21.1%(12/57),局部复发率10.5%(6/57),颈部复发率28.1%(16/57),喉部分切除的局部复发率12.0%(3/25).生存率随分期下降,T1+T2与T3+T4和N0+N1与N2+N3的生存率差异分别有显著性(x2=4.942,P=0.026;x2=4.306,P=0.038).单纯手术与手术结合放射治疗的生存率差异无显著性,N2和N3患者的手术结合放射治疗相对优于单纯手术.结论喉声门上型低分化鳞癌患者以晚期病变为主,易较早发生淋巴结转移,颈部转移和远处转移率较高,治疗仍以手术为主,喉部分切除术是可行的,T3病变的喉部分切除和颈部N分级较晚的患者应手术结合放射治疗.     

声门下型喉鳞状细胞癌的临床探讨

目的 探讨声门下型喉鳞状细胞癌(简称鳞癌)的临床特点、淋巴转移规律、治疗模式及预后相关因素.方法 回顾性分析中国医学科学院肿瘤医院头颈外科1970-2005年初治的36例声门下型喉鳞癌患者的临床资料,其中Ⅰ期6例,Ⅱ期9例,Ⅲ期8例,Ⅳ期13例.单纯放疗8例,单纯手术18例,手术加放疗10例.分析不同分期、不同治疗方式的生存情况.采用Kaplan-Meier法计算生存率,Log-Rank法作差异检验,不同组间率的比较采用卡方检验.结果 除3例患者无瘤状态下失访外,其余33例均随访5年以上或至死亡.5年生存率为58.2％,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期5年生存率分别为66.7％、66.7％、62.5％、30.8％,Ⅰ～Ⅲ期与Ⅳ期两组比较差异有统计学意义(x2=3.955,P＜0.05);单纯放疗、单纯手术、手术加放疗的5年生存率分别为43.8％、66.7％、51.9％.淋巴转移率为25.0％ (9/36),阳性淋巴结主要分布在Ⅵ区,其次为Ⅱ区.NO、N+患者的5年生存率分别为66.7％、20.8％,两组差异有统计学意义(x2 =6.466,P＜0.05).结论 声门下型喉鳞癌预后相对较差.喉全切除术是该型喉鳞癌主要的治疗方式,仅部分早期患者可行单纯放疗或喉部分切除术.局部晚期患者在手术同期应行颈部Ⅱ～Ⅳ区及Ⅵ区的淋巴清扫术.     

9例喉疣状癌和乳头状鳞状细胞癌的临床分析

目的：探讨喉疣状癌（VC）和乳头状鳞状细胞癌（PSCC）的临床、病理特点及鉴别诊断。方法：回顾性分析我院收治的4例喉VC及5例PSCC的临床资料,观察喉Vc及PSCC的临床及病理学特点。结果：4例喉VC均可见鳞状上皮高度增生,伴有角化珠形成,基底膜不受侵犯,肿瘤基质可见中至重度炎性浸润,未见颈部淋巴结转移,无局部复发,预后良好。5例喉PSCC均可见外生性恶性增殖并有血管纤维核心的鳞状细胞,细胞病理学表现与传统的鳞状细胞癌（SCC）基本一致,未见颈部淋巴结转移,预后较传统SCC好。结论：VC和PSCC两者在外观上较相似,但肿瘤细胞的分化、异型性,间质的炎性浸润,复发,局部转移,治疗及预后等方面存在差异,临床及病理医生需密切配合检查,以便鉴别诊断两类疾病。     

喉声门上型低分化鳞状细胞癌57例临床观察

目的 探讨喉声门上型低分化鳞状细胞癌(简称鳞癌)的临床特点、治疗及预后。方法 回顾分析1980～1998年我院57例喉声门上型低分化鳞癌病例(1997年UICC分期：Ⅰ期4例，Ⅱ期5例，Ⅲ期18例，Ⅳ期30例)。单纯手术25例，单纯放射治疗9例，术前放射治疗加手术14例，手术加术后放射治疗7例，术前化学治疗加手术2例。喉全切除23例，喉部分切除25例；同期颈清扫31例(单侧17例，双侧14例)，上颈清扫12例。结果5年生存率47．4％(27／57)，颈部转移率63．2％(36／57)，双颈转移率24．6％(14／57)，远处转移率21．1％(12／57)，局部复发率10．5％(6／57)，颈部复发率28．1％(16／57)，喉部分切除的局部复发率12．0％(3／25)。生存率随分期下降，T1 T2与13 T4和N0 N1与N2 N3的生存率差异分别有显著性(χ^2=4．942，P=0．026；χ^2=4．306，P=0．038)。单纯手术与手术结合放射治疗的生存率差异无显著性，N2和N3患者的手术结合放射治疗相对优于单纯手术。结论 喉声门上型低分化鳞癌患者以晚期病变为主，易较早发生淋巴结转移，颈部转移和远处转移率较高，治疗仍以手术为主，喉部分切除术是可行的，T3病变的喉部分切除和颈部N分级较晚的患者应手术结合放射治疗。     

10例喉非鳞状细胞癌的临床特征分析

原发于喉的恶性肿瘤绝大多数为鳞状细胞癌，非鳞状细胞癌比较少见，其病理类型很多，在诊断和治疗上与喉鳞状细胞癌相比有其特点。现将我科收治的10例原发于喉的非鳞状细胞癌病例资料进行复习，报告如下。     

喉鳞状细胞癌多原发癌81例临床报道

目的探讨喉鳞状细胞癌（简称鳞癌）多原发癌（multiple primary cancels，MPC）患者的临床特点及生存状况。方法回顾性分析1101例喉鳞癌患者中81例MPC的临床和随访资料，用Kaplan—Meier法计算生存率。结果本组喉鳞癌MPC发生率为7．4％（81／1101）。其中头颈部MPC29例（占35．8％），口腔癌和鼻咽癌最多见，有放疗史的患者较易并发头颈部MPC（X^2=5．7，P=0．017）；非头颈部MPC52例（占64．2％），以肺癌（25．9％，21／81）和食管癌（22．2％，18／81）最多见。本组消化道MPC37例（占45．7％），呼吸道MPC32例（占39．5％）。同时性MPC14例（占17．3％），中位发生时间2个月；异时性MPC67例（占82．7％），中位发生时间28个月。本组MPC病理类型以鳞癌（占66．7％）最多见，有吸烟、饮酒史的患者较易发生多原发鳞癌（P=0．007）。声门上型先证喉癌MPC中，食管癌和1：3咽癌的发生率较高（P=0．04）；声门型先证喉癌MPC中，口腔癌、鼻咽癌和肺癌的发生率较高（P=0．006）。本组总的3、5年累积生存率分别为45．2％，29．7％。其中积极治疗组（53例）5年生存率达45．5％，而因故放弃治疗患者（28例）3年生存率为0，二者比较差异有统计学意义（P=0．000）。结论喉鳞癌MPC以肺癌和食管癌最常见。有放疗史的患者较易发生头颈部MPC。有吸烟、饮酒史的患者较易发生多原发鳞癌。MPC对喉鳞癌患者预后影响较大，积极有效的治疗是提高这类患者生存率的关键。     

颈Ⅱ和Ⅲ区清扫术治疗cNO声门上型喉鳞状细胞癌

目的 研究择区性即ⅡA、ⅡB和Ⅲ区颈淋巴结清扫术(selective neck dissection,SND)治疗临床颈淋巴结阴性(clinical node negative,cN0)的声门上荆喉鳞癌隐匿性颈转移的可行性.方法 回顾性分析2002年10月至2006年3月在哈尔滨医科大学肿瘤医院头颈外科行SND(ⅡA、ⅡB和Ⅲ区)治疗52例cN0声门上型喉癌的治疗结果.结果 52例cNO声门上型喉癌中32例同期行单侧(ⅡA、ⅡB和Ⅲ区),20例行双侧SND.52例颈清扫标本病理检查发现,颈转移阳性者15例(28.9%).3例首次病理检查阴性者在随访中发生未手术侧颈部转移,总的颈隐匿性转移率为34.6%(18/52),单侧、双侧隐匿性颈转移率分别为28.8%和5.8%.72侧颈清标本共获淋巴结1190枚,其中病理阳性30枚,分布于ⅡA区25枚(83.3%)、Ⅲ区5枚(16.7%).术侧颈部复发率为5.8%(3/52).Kaplan-Meier法统计3年累积生存率为84.6%.淋巴结病理阴性和阳性的颈部复发率分别为0(0/34)和16.7%(3/18),差异有统计学意义(Fisher精确检验,P=0.021),有无包膜外侵犯的颈部复发率分别为50%(2/4)和2.1%(1/48),差异有统计学意义(Fisher精确检验,户=0.002).结论 颈SND(ⅡA、ⅡB和Ⅲ区)治疗cNO声门上型喉癌颈隐匿性转移是可行的,该术式能缩短手术时间、减少并发症且不影响肿瘤治疗效果.     

喉鳞状细胞癌的体外原代培养

利用体外组织培养方法对１１组喉鳞状细胞癌标本进行原代培养。结果原代培养平时时间２月，培养成功率６３．６％（７／１１），并可继续传代，介绍了组织块培养和胰蛋白酶消化分离培养两种方法以及去除成纤维细胞的方法。讨论了喉鳞癌原代培养中的注意事项。     

喉声门型癌Ⅲ期病变临床治疗

目的比较不同治疗方案对喉声门型癌T3N0M0病变预后的影响,优化临床治疗.方法分析1992年～1999年我院采用喉垂直部分切除术、喉全切除术和根治性放射治疗等方案治疗的65例喉声门型癌T3N0M0病变的临床资料,比较不同治疗的总体生存率、原发部位及颈部淋巴结复发率和喉功能保留率.结果Cox分析显示三种治疗方案的总体生存率、原发部位和颈部淋巴结复发率无显著性差异（P＞0.05）;喉垂直部分切除术和根治性放射治疗的喉功能保存率高,差异有显著性（P＜0.01）.结论三种方案治疗喉声门型癌T3N0M0病变,总体生存率和复发率无差异,喉垂直部分切除术和根治性放疗有利于保留喉功能.     

环加氧酶-2在声门上型喉鳞状细胞癌中的表达及预后

目的:研究环加氧酶-2(Cox-2)在声门上型喉鳞状细胞癌(SGLSCC)中的表达,与血管生成的关系及预后意义,明确其作为生物学标记物在SGLSCC中的作用。方法:应用免疫组织化学染色及反转录-聚合酶链反应(RT-PCR)方法研究88例手术治疗的原发SGLSCC标本,术后随访6~102个月,平均63个月。结果:SGLSCC中Cox-2表达的阳性率为94.3%(83/88),而对照组癌旁组织正常的喉黏膜组织则无1例有Cox-2蛋白的表达;分化好的较分化差的癌组织Cox-2表达升高。SGLSCC的Cox-2mRNA相对含量为141.871±20.543 5,正常癌旁组织为17.031±2.259 7,差异有统计学意义(P<0.01)。在各临床病理参数中,仅Cox-2阳性率与病理分级有显著的负相关关系(P<0.01)。Cox-2阳性率与微血管密度(MVD)间有显著的负相关性(P<0.01),Cox-2强度与MVD间呈显著的正相关关系(P<0.01)。Cox-2强度与SGLSCC患者术后累积生存率有显著联系(P<0.05),Cox-2阳性率则无(P>0.05)。Cox-2强度是SGLSCC患者术后生存的最显著的独立预后因素(P<0.01)。结论:在SGLSCC中,Cox-2从蛋白到mRNA水平显著一致的高表达,Cox-2的表达与肿瘤尤其是高分化肿瘤的发生及发展有关,其在正常喉黏膜组织到癌变这一衍化发展中起着重要作用。Cox-2的表达与肿瘤的血管形成是同步变化的;Cox-2强度是SGLSCC患者最显著的独立预后因素,其有望成为临床预防和治疗喉鳞状细胞癌等头颈部肿瘤及判定预后的有效靶目标。     

BUB1在喉鳞状细胞癌中的表达及临床意义

目的：探讨喉鳞状细胞癌（LSCC）组织中BUB1蛋白的表达及临床意义。方法：采用免疫组织化学EliVision二步法检测55例LSCC组织和30例癌旁正常黏膜组织中BUB1蛋白的表达,并分析其与LSCC临床病理特征的关系。结果：BUB1蛋白在LSCC组织中的阳性表达率为50．9％（28／55）,低于癌旁正常黏膜组织83．3%（25／30）,两者比较差异有统计学意义（P〈0．01）;BUBl蛋白的表达与LSCC分化程度及淋巴结转移有相关性（均P〈0．05）,而与患者性别、年龄、吸烟、肿瘤原发部位、T分期及临床分期无相关性（均P〉0．05）。结论：BUBl蛋白的低表达与LSCC的发生、发展有关,BUB1可能作为预测LSCC转移及预后的生物学指标之一。     

Horizontal partial laryngectomy for supraglottic squamous cell carcinoma

Between 1981–1999, 75 patients treated for supraglottic SCC with horizontal supraglottic laryngectomy (HSL) at the Otolaryngology Head and Neck Surgery Department of Lausanne University Hospital were retrospectively studied. There were 16 patients with T1, 46 with T2 and 13 with T3 tumors. Among these, 16 patients (21%) had clinical neck disease corresponding to stage I, II, III and IV in 12, 39, 18 and 6 patients, respectively. All patients had HSL. Most patients had either elective or therapeutic bilateral level II–IV selective neck dissection. Six patients (8%) with advanced neck disease had ipsilateral radical and controlateral elective II–IV selective neck dissections. Adjuvant radiotherapy was given to 25 patients (30%) for either positive surgical margins (n=8), pathological nodal status (n=14) or both (n=3). Median follow-up was 48 months (range, 24–199). Five-year disease-specific survival and locoregional and local control were 92, 90 and 92.5%, respectively. Among five patients who were diagnosed with local recurrence, one had a total laryngectomy (1.4%); the others were treated by endoscopic laser surgery. Two patients had both a local and regional recurrence. They were salvaged with combined surgery and radiotherapy, but eventually died of their disease. Cartilage infiltration seems to influence both local control (P=0.03) and disease-specific survival (P=0.06). There was a trend for worse survival with pathological node involvement (P=0.15) and extralaryngeal extension of the cancer (P=0.1). All patients except one recovered a close to normal function after the treatment. Aspiration was present in 16 patients (26%) in the early postoperative period. A median of 16 days (7–9) was necessary to recover a close to normal diet. Decannulation took a median of 17 days (8–93). Seven patients kept a tracheotomy tube for up to 3 months because of persistent aspiration. There was no permanent tracheostomy or total laryngectomy for functional purposes. Horizontal supraglottic laryngectomy remains an adequate therapeutic alternative for supraglottic squamous cell carcinoma, offering an excellent oncological outcome. The postoperative functional morbidity is substantial, indicating the need for careful patient selection, but good laryngeal function recovery is the rule. The surgical alternative is endoscopic laser surgery, which may offer comparable oncological results with less functional morbidity. Nevertheless, these two different techniques need to be compared prospectively.This paper was presented at the 2nd World Congress of the International Federation of Head and Neck Oncologic Societies, Rio de Janeiro, Brazil, 29 November–2 December 2002.     

Oncological outcomes of surgical treatment for T3 supraglottic laryngeal squamous cell carcinoma patients

Abstract

Background: T3 supraglottic laryngeal carcinoma (LC) is a common advanced laryngeal cancer.

Objective: This study was conducted to assess the clinical results of pathological T3 (pT3) supraglottic LC patients who were amenable to laryngectomy treated with primary surgery and postoperative therapy.

Methods: Retrospective review of 202 pT3 cases of supraglottic laryngeal squamous cell carcinoma.

Results: The five-year cancer specific survival (CSS) rate was 63.7% and the overall survival rate (OS) was 62.8%. For T3 supraglottic patients who underwent total laryngectomy, the five-year disease-free survival (DFS) was 51.8%, and the CSS was 62.5%. For patients who underwent partial laryngectomy, the five-year DFS was 72.2%, and the CSS was 79.0%. High lymph node and stage status are predictors of mortality for these patients. No difference was found in the DFS and CSS rates between patients with negative margins and those with positive margins following postoperative radiotherapy and chemotherapy.

Conclusion: Surgical treatment of T3 supraglottic LC patients achieved satisfactory results. Postoperative radiotherapy and chemotherapy are an effective method of treatment for T3 supraglottic LC patients, especially for those with a positive margin.     

Basaloid squamous cell carcinoma of the supraglottic larynx

Basaloid squamous cell carcinoma (BSC) is regarded as a variant of squamous cell carcinoma, but displays distinct morphological and biological features as well as a different clinical course. The tumor is frequently seen in the head and neck and is preferentially located in the larynx, especially in supraglottic sites. Ten patients with BSC of the supraglottic larynx were treated from 1991 to 1995 at the Medical Faculty of the University of Istanbul. Results of treatment were compared retrospectively with a control group consisting of 44 patients with well-differentiated squamous cell carcinomas. Ages, ¶localizations, stages and treatment procedures were similar. In both groups mean survival, nodal involvement and distant metastases were comparable although the local ¶(laryngeal) recurrence rate in patients with early supraglottic (T2) disease in the BSC group after conservative partial surgery was distinct compared to the control group (P < 0.05). These results indicate that conservative surgery should be assessed with caution in patients with BSC, and postoperative irradiation be taken into consideration.     

胰岛素样生长因子-Ⅰ受体和蛋白激酶C在喉鳞状细胞癌中的表达及意义

目的:探讨胰岛素样生长因子-I受体(IGF-IR)和蛋白激酶C(PKC)在喉鳞状细胞癌中的表达情况及临床意义。方法:采用免疫组织化学SP法及Westernblot技术检测60例喉鳞状细胞癌组织、25例癌旁组织及10例正常喉部组织中IGF-IR及PKC的表达情况。结果:IGF-IR及PKC在喉鳞状细胞癌中的表达阳性率较正常喉部组织及癌旁组织明显增高(P<0.05)。IGF-IR在TNM分期Ⅲ～Ⅳ期、颈淋巴结转移及高分化癌患者中的表达水平分别较Ⅰ～Ⅱ期、无淋巴结转移及中低分化癌患者表达增强(P<0.05)。PKC的阳性表达与喉癌临床分期及淋巴结转移相关(P<0.05)。喉鳞状细胞癌组织中IGF-IR与PKC蛋白的表达呈正相关(rs=0.338,P<0.05)。结论:IGF-IR及PKC在喉鳞状细胞癌中表达增高且两者密切相关,可能参与了喉癌的发生、发展过程,检测IGF-IR和PKC的表达对喉癌的早期诊断及治疗具有重要指导意义。     

喉鳞癌血管内皮生长因子的表达及其临床意义

目的　研究喉鳞癌组织中血管内皮生长因子 (vascularendothelialgrowthfactor,VEGF)的表达及其临床意义。方法　用免疫组化ABC法对 33例喉鳞状细胞癌和 15例声带息肉标本进行血管内皮生长因子测定和肿瘤微血管密度 (microvesseldensity ,MVD )记数。结果　喉癌组织中VEGF的表达程度与MVD呈正相关(P <0 .0 1) ;喉癌组织中 ,VEGF阳性表达率高于声带息肉组织中的VEGF阳性表达率 (P <0 .0 1) ;VEGF表达与病人年龄、病变部位和喉鳞癌细胞分化程度无关 (P >0 .0 5 ) ;VEGF表达与喉鳞癌T分期和颈淋巴结转移呈正相关 (P <0 .0 1) ,而与病人预后呈负相关 (P <0 .0 1)。结论　VEGF在喉鳞癌中有高表达 ,VEGF的表达与新生血管密切相关 ,VEGF的表达程度与喉鳞癌T分期和颈淋巴结转移有关 ,可作为判断喉鳞癌病人预后的参考指标。     

Therapeutic influence on circulating and monocyte-derived dendritic cells in laryngeal squamous cell carcinoma patients

Conclusion: Surgical resection of laryngeal squamous cell carcinoma (LSCC) could be associated with improved circulating myeloid dendritic cell (mDC) number and monocyte-derived dentritic cell (MoDC) function. Although adjunctive radiotherapy after surgery did not effect the normalization of mDC number, it may have an impact on MoDC function. Objective: To investigate the effects of surgery and adjunctive radiotherapy on both circulating dendritic cells (DCs) and MoDCs of LSCC patients. Subjects and methods: Forty-six patients with LSCC and 15 age-matched healthy control subjects were enrolled in this study. Blood samples were taken before, during, and after conventional treatment from both patients who underwent surgery only (n=18) and those who had adjunctive radiotherapy after tumor removal (n=28),. Three-color flow cytometry was used for determination of circulating DC subsets. Moreover, MoDCs were generated utilizing granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4), then the phenotype of MoDCs was measured by flow cytometry and the ability to stimulate autologous T cells was tested in a mixed leukocyte reaction (MLR). Results: The preoperative mDC counts, MoDC surface molecular expression and stimulatory capacity were impaired in patients in comparison with controls. The number of mDCs and the expression of CD80, CD83, and HLA-DR on MoDCs were significantly increased as compared with those pretreatment in patients who underwent surgery only and in those who had surgery followed by adjunctive radiotherapy. However, the recovery of CD86 expression and allostimulatory activity was only observed in patients who underwent surgery alone.     

The role of acid and alkaline reflux in laryngeal squamous cell carcinoma

HYPOTHESIS: At present, main factors considered responsible for the onset of squamous cell carcinoma are tobacco smoking, alcohol abuse, and exposure to viral and toxic agents. In last years, great interest has been focused on gastroesophageal reflux as independent carcinogenic factor and co-carcinogen in association with smoking and alcohol assumption. STUDY DESIGN: Initially, the aim of this study was to objectively evaluate the presence of distal and proximal esophageal reflux with multielectrode pH measurement in patients with cancer of the larynx and/or hypopharynx (group A). However, in the course of the study, pharyngolaryngeal cancer was also observed in 4 patients with achlorhydria; therefore, the hypothesis that alkaline reflux might be involved in the onset of laryngeal cancer was tested (group B). METHODS: Twenty-one consecutive patients with laryngeal or hypopharyngolaryngeal squamous cell carcinoma (group A) entered the study. Twenty-one patients without laryngo-pharyngeal diseases were used as control subjects. A validated questionnaire of the clinical history was completed by all patients who underwent 24-hour pH monitoring. Group B included 40 consecutive gastrectomized patients (28 males and 12 females) in whom biliary or alkaline reflux was directly consequent to Billroth I or Billroth II operation. The control group was composed of 40 non-gastrectomized dyspeptic patients. The clinical history was controlled and obtained; EDGS and ENT examination with videolaryngoscopy was performed in all patients. RESULTS: In group A, pH measurement showed pathological reflux in 80.9% (17 of 21) of patients with no typical symptoms in 63.7% of them. The difference was significant with respect to the control group. In group B, 6 of 40 (15%) had preneoplastic lesions or a history of laryngeal tumor. The difference was significant with respect to the control group. A total of 7.5% of group B patients had previously undergone CO2 laser cordectomy for laryngeal squamous cell carcinoma and 7.5% had leukoplakia. We found a significantly higher incidence (<.05) of neoplastic and preneoplastic disease of the larynx in patients undergoing Billroth II and total gastrectomy than in those undergoing Billroth I and Roux-en-Y resection. We also found a significant increase (<.01) in ENT lesions in the group of patients who had undergone gastrectomy more than 20 years previously. CONCLUSIONS: In agreement with literature reports, results obtained in group A confirmed that gastroesophageal reflux is often present in patients with neoplastic lesions of the pharynx and larynx. Furthermore, gastric resection is indicated for the first time as an additional risk factor or cofactor of precancerosis and squamous cell carcinoma of the pharynx or larynx. Further studies are necessary to establish the cause and effect relationship between biliary reflux and pharyngo-laryngeal tumors.     

上颌窦鳞状细胞癌60例临床分析

目的 总结上颌窦鳞癌的临床特点及治疗方法对其预后的影响.方法 回顾性分析中国医学科学院北京协和医学院肿瘤医院头颈外科1994年1月至2004年12月60例初治的上颌窦鳞癌患者的临床资料,按照治疗方式的不同分为单纯放疗组,术前放疗+手术(radiotheraphy+surgery,R+S)组以及同步放化疗+手术治疗(concurrent cherho-radio-therapy+surgery,CCR+S)组.其中单纯放疗组22例,R+S组29例,CCR+S组9例.结果 单纯放疗组5年的生存率为18.2%,综合治疗组总的5年的生存率分别为47.4%,其中R+S组的5年的生存率为51.7%,CCR+S组5年生存率为33.3%,综合治疗组与单纯放疗组之间比较,差异有统计学意义(x2=9.49,P<0.01),单纯放疗组与R+S组之间比较,差异有统计学意义(x2=15.62,P<0.01).R+S组与CCR+S组比较,差异有统计学意义(x2=4.28,P<0.05).结论 R+S综合治疗是上颌窦鳞癌的主要治疗方式,积极采取R+S综合治疗方式可有效延长患者的生存期提高生存率.CCR+S的治疗方式在上颌窦鳞癌治疗中的作用有待进一步观察.