1115例喉癌患者的生存分析

目的　了解 2 0世纪 80～ 90年代外科治疗喉癌的远期效果 ,并且探讨影响预后的因素。方法　应用回顾性调查的方法 ,对 1983～ 1996年间中国医科大学第一附属医院耳鼻咽喉科 1115例喉癌患者进行分析 ,统计患者的生存率和死亡原因。结果　生存 5年以上者 780例 ,死亡 2 6 0例 ,失访75例 ,累积生存率曲线统计 5年生存率为 77% ,其中Ⅰ期为 94 %、Ⅱ期为 89%、Ⅲ期为 82 %、Ⅳ期为6 6 %。不同分型的 5年生存率由高到低的顺序是声门型、声门上型、声门下型、跨声门型。喉部分切除术患者的 5年生存率为 85 % ,而喉全切除术患者的 5年生存率为 6 8%。患者 5年内死亡的主要原因是局部复发和转移 (70 % ) ,另有 14 %的死亡者没有弄清他们的死亡原因。结论　近 2 0年我国喉癌治疗水平得到明显提高 ,早期诊断是提高喉功能保留手术比例和提高生存率的关键 ,患者 5年内死亡的原因主要是局部复发和转移。     

喉癌手术后迟发性感染20例报告

报告２０例喉癌患者术后发生迟发性感染，患者主要为行喉全切除术或次全喉切除术并喉重建或在部分喉切除同时行喉修复手术者。迟发性感染多发生在术后半年，其预后不良，肿瘤复发率及死亡率较高，故需认真预防和治疗，并就有关的防治的具体措施进行讨论。     

喉癌术后复发的临床因素分析

目的：探讨影响喉癌术后复发的临床因素,方法：对1991年1月－1998年6月间收治的21例复发性喉癌进行复发原因分析。结果：局部复发15例（3例局部复发伴颈淋巴结转移）,其中前联合及对侧喉腔5例,同侧喉腔2例,会厌前间隙2例,声门下区1例,喉前软组织1例、下咽部1例,声门旁隙及喉前软组织1例,下咽及颈前软组织2例,颈淋巴结转移复发6例,主要位于淋巴结levelⅡ、Ⅲ。结论：正确掌握喉癌的分期及分型,选择合理术式,了解各型喉癌的病理发展规律坷以减少复发机会。     

改良Majer-Piquet手术治疗晚期声门型喉癌21例报告

目的探讨改良Majer-Piquet手术的可行性及远期疗效。方法应用会厌下移,环(气管)软骨会厌固定术治疗声门型晚期喉癌21例。结果3年和5年的生存率分别为100%和85.7%,术后拔管率为95.2%,患者拔管后即可发音,所有患者均可经口进食。结论改良手术扩大了手术的适应证,该手术既能根治病变,又能较好地保留喉功能。     

315例外科治疗喉癌患者的生存分析

目的：分析20世纪80年代到21世纪初外科治疗喉癌的远期效果,并且探讨影响预后的因素。方法：应用回顾性调查的方法对315例喉癌患者进行分析,统计患者的生存率和死亡原因。结果：生存5年以上者233例,死亡60例,失访22例。累计生存率曲线统计5年生存率为73．97％,其中早期（Ⅰ期、Ⅱ期）为82．69％,晚期（Ⅲ、Ⅳ期）为62．64％。不同分型的5年生存率分别为声门上型73．76％,声门型82．55％,声门下型55．56％,跨声门型68．75％。喉部分切除术的5年生存率79．89％,喉全切术的5年生存率61．03％。患者5年内死亡的主要原因是局部复发和颈淋巴结转移。结论：早期诊断是提高喉功能保留手术比例和提高生存率的关键,严格掌握各术式适应证,保留足够的安全切缘并加强术后随访是提高生存率的根本。     

喉癌患者的甲状腺机能变化

本文采用放射免疫测定法对３９例喉癌患者和４０例健康老年人的血清Ｔ３、Ｔ４进行测定，以观察喉癌患者甲状腺机能变化。结果是Ｔ３前者较后者明显降低，经ｔ检验有极显著差异（Ｐ〈０．０１）；Ｔ４两者无显著差异（Ｐ〉０．０５）。同时表明患者有的甲状腺机能与伤口愈合和预防咽瘘有明显关系。因此认为，喉癌患者行手术治疗时，不论是否已行放疗，术前和术后均应检测甲状腺功能，以对术后愈合提供参考。     

晚期喉癌患者术后生存回顾性分析

目的:比较临床Ⅲ、Ⅳ期喉癌患者部分喉及全喉切除术后的生存情况。方法:回顾性分析我科行手术治疗的126例临床Ⅲ、Ⅳ期喉癌患者,用乘积限法进行生存分析,比较各因素与晚期喉癌术后患者生存率的关系。结果:126例患者中临床Ⅲ期80例,临床Ⅳ期46例。行部分喉切除术65例,行全喉切除者61例。126例患者中5年内共死亡24例,其中部分喉切除者15例,全喉切除者9例。部分喉切除术、全喉切除术5年生存率分别为62.58%、68.74%。2组患者生存曲线差异无统计学意义(P<0.05)。结论:对于晚期喉癌患者,在手术适应证掌握良好的前提下,可行部分喉切除术,其5年生存率与行全喉切除术者差异无统计学意义。     

不同术式喉癌患者手术前后心理状况变化分析

目的　探讨不同术式喉癌患者术前与术后心理状况变化情况。方法　采用症状自评量表（SCL-90）对41例喉癌患者在术前以及术后1、6个月的心理状态进行评估,并与国人常模进行比较。结果　SCL-90评分结果显示术前喉癌患者在总分及躯体化、焦虑、抑郁３个因子分均明显高于正常对照组;喉全切除患者术后在总分及躯体化、焦虑、抑郁、偏执４个因子分高于正常对照组和喉部分切除患者,术后1、6个月的总分及各因子分无明显改变。喉部分切除患者术后1个月时除焦虑因子分高于正常对照组,总分及其他因子分与正常对照组无明显差异,而术后6个月总分及各因子分与正常对照组无明显差异。结论　喉癌患者术前存在不良心理状况,不同手术方式对喉癌患者术后心理状况存在不同影响。提示在手术治疗喉癌的同时应关注患者的心理状况并在术后根据不同术式的患者采用不同的心理干预 以帮助其改善生存质量。     

44例喉部分切除术的临床分析

目的：研究喉部分切除术的疗效。方法：回顾分析了我科自1987－1993年间44例喉癌患者行喉部分切除术的临床资料。其中，声门型25例，声门上型18例，声门下型1例；Ⅰ-Ⅱ期24例，Ⅱ-Ⅳ期20例，结果：全部病例的言语功能均不同程度的恢复，均能经口进食，总的拔管率为73．3％，Ⅰ-Ⅱ期的5年生存率为87．5％，Ⅲ-Ⅳ期的5年生存率为65％，总的5年生存率为77．27％。结论：喉部切除术是治疗喉癌的有效方法之一，但对一些晚期喉癌病例需要慎重选择。     

未行喉切除术及放化疗治疗的喉癌患者生存分析

目的 探讨未接受喉切除术及放化疗治疗喉癌患者的生存率及其预后因素.方法 回顾性分析167例未行喉切除术及放化疗治疗喉癌患者的临床资料,应用Kaplan-Meier法计算生存率,单因素分析组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型.结果 167例患者总的生存时间为(16.0±1. 4)个月(-x±s),1年、2年生存率分别为56.4%、26.5%;确诊超过5年的病例(除失访者外)尚无一例生存超过5年.单因素分析显示不同的肿瘤生长部位、病理分级、T分期、N分期对生存率的影响差异有统计学意义(P值均＜0.05).而行气管切开术的喉癌患者生存率与未行气管切开术者相比,差异无统计学意义(P＞0.05).多因素分析显示不同T分期、N分期对生存率的影响差异有统计学意义(危险比分别为1.812和1.557,P值均＜0.05).结论 喉癌病程发展较快,在未针对肿瘤本身治疗的情况下,姑息性手术如气管切开术并不能提高生存率.影响喉癌预后的因素为肿瘤生长部位、病理分级、T分期、N分期和临床分期,其中相对独立预后危险因素为T分期和N分期.

Abstract：

Objective To investigate the survival rate and prognostic factors of laryngeal carcinoma patients with no surgery,radiotherapy or chemotherapy.Methods One hundred and sixty-seven laryngeal carcinoma cases with no surgery,radiotherapy or chemotherapy were analyzed restrospectively.Survival rates were calculated by Kaplan-Meier product-limit method.With univariate analysis,comparisons among/between groups were performed using Log-rank test.Multivariate analysis was carried out using Cox proportional hazard model.Results Overall survival time was (16.0 ± 1.4) months (-x ± s),overall 1-and 2-year survival rates were 56.4％ and 26.5％,respectively.No patient survived over 5 years in these cases who had been diagnosed more than 5 years (except for those who lost).Univariate analysis showed that primary site,pathological grade,T-stage,N-stage and clinical stage were significant prognostic factors for the survival of the patients (P ＜ 0.05＝.The survival rates of laryngeal carcinoma whether with tracheotomy were no statistically significant (P＞0.05).Multivariate analysis showed survival rates statistically correlated with T stage and N stage (hazard ratio were 1.812 and 1.557,P ＜ 0.05).Conclusions The development of laryngeal carcinoma course was faster,without treatment to the tumor itself,even if palliative surgical such as tracheostomy would not improve the survival rate.In laryngeal carcinoma patients with no surgery,radiotherapy or chemotherapy,the factors affecting the survival rates include primary site,pathological grade,T-stage,N-stage and clinical stage,and of them,T-stage and Nstage are the independent prognostic factors.     

Survival after laryngectomy: a review of 133 patients with laryngeal carcinoma

Survival trends in survival for laryngeal cancer in Europe are varied. Five-year survival varied around 60–64% but numbers below 50% have been commonly reported. The aim of this study was to assess the factors influencing survival in patients with laryngeal cancer in our region. A total of 128 male and 5 female patients with larynx cancer (91 glottic and 42 supraglottic) were treated at Patras University Hospital between March 1992 and August 2004. Except 3, all were smokers and 56 (41%) heavy alcohol users. Postsurgical staging showed that most had been classified at stages III (38%) and IV (49%). By histology, 31 tumors were classified as poorly differentiated, 78 as moderately differentiated and 23 as well differentiated. All patients underwent laryngectomy with extension of the procedure where appropriate. Also, a total of 45 patients received adjuvant therapy (either chemotherapy or radiotherapy). Farmers, construction workers, professional drivers and mechanics and coffee shop and bar employees account for more than 70% of patients. Results showed that 64 (48.1%) patients died during the follow-up, 58 (43.6%) of them died from cause related to their disease. With a median follow-up of 25 months, the 5-year disease-free survival (DFS) was 53% and the 5-year overall survival (OS) was 45%. Significant prognostic factors for OS included patient age, advanced staging, heavy alcohol use and poor tumor differentiation while for DFS affected mainly by poor tumor differentiation. We conclude that the disease stage at presentation, tumor grade and alcohol consumption prove to be important predictors for the OS as well as the DFS in our series.     

Laryngeal carcinoma with laryngeal abscess]

We had encountered 5 cases of laryngeal carcinoma associated with abscess. Four of them were advanced laryngeal cancer with abscess induced by mechanical injury, and one with post-radiation laryngeal perichondritis & abscess formation. Management included total laryngectomy in 3 patients, partial laryngectomy in 1 patient, and resection of post-radiation abscess in one. Laryngeal abscesses are seen rarely today. Endeavour should be made to decrease such complication. The authors had presented their experience in the management of laryngeal carcinoma associated with laryngeal abscess, together with a review of the history and some of the current ideas about this problem.     

Survival analysis of laryngeal carcinoma without laryngectomy, radiotherapy, or chemotherapy

This study aimed at investigating the survival rate and prognostic factors of laryngeal carcinoma patients in the absence of the use of laryngectomy, radiotherapy, and chemotherapy. A total of 167 cases of laryngeal carcinoma without the use of laryngectomy, radiotherapy, or chemotherapy were analyzed retrospectively. Surveyed items included age, smoking history, tumor family history, tuberculosis history, primary site, pathological grade, T-stage, N-stage, clinical stage, and whether tracheotomy had been performed. Survival rates were calculated using the Kaplan–Meier method. For univariate analysis, comparison among/between groups was performed using the log-rank test. Multivariate analysis was carried out using the Cox proportional hazard model. Overall median survival time was 16?±?1.44?months, and overall 1- and 2-year survival rates were 56.4 and 26.5%, respectively. No patient survived over 5?years in cases diagnosed for more than 5?years (except for cases that were lost). The median survival time of clinical stage 0/I/II was 28?±?3.81?months, and 1- and 2-year survival rates were 79.3 and 59.3%, respectively; the median survival time of III/IV clinical stages was 11?±?1.32?months, and 1- and 2-year survival rates were 45.5 and 10.6%, respectively. Univariate analysis showed that primary site, pathological grade, T-stage, N-stage, and clinical stage were significant prognostic factors for the survival of the patients (P?<?0.05). Whether tracheotomy had been performed was not significant for affecting survival rates. Multivariate analysis showed survival rates were statistically correlated with T-stage and N-stage (P?<?0.05). The development of laryngeal carcinoma course was faster, without treatment to the tumor itself, even if palliative surgery such as tracheostomy would not improve the survival rate. In laryngeal carcinoma patients with no surgery, radiotherapy or chemotherapy, the factors affecting the survival rates include primary site, pathological grade, T-stage, N-stage, and clinical stage, and of them, T-stage and N-stage are the independent prognostic factors.     

Retrospective analysis of 659 laryngeal squamous cell carcinoma patients treated with open laryngeal function-preserving operations

Abstract

Background: Open laryngeal function-preserving surgery is a common therapeutic strategy for Chinese laryngeal squamous cell carcinoma (LSCC) patients.

Objectives: To explore the fundamental clinical characteristics and survival prognostic factors of LSCC patients treated with open laryngeal function-preserving operations.

Material and methods: about a total of 659 LSCC patients undergoing open laryngeal function-preserving operations were retrospectively reviewed. Kaplan–Meier method, Log-rank test and Cox regression model were performed in survival analyses.

Results: About 612 patients were glottic cancer, followed by 44 cases in supraglottis and 3 cases in subglottis. The number of patients in stage T1, T2, T3 and T4 was 190, 365, 100 and 4, respectively. Nineteen patients had positive cervical lymph nodes. The 5-year overall survival, disease-free survival and disease-specific survival rates were 90.1, 84.9 and 90.7%, respectively. T stage and second primary tumour were independent factors predicting overall survival, while T stage and pathological differentiation were independent risk factors for tumour recurrence and progression.

Conclusions and significance: Open laryngeal function-preserving surgery is a crucial therapeutic strategy for Chinese patients with early and, in some cases, advanced-stage LSCC. Early diagnosis and therapy and sufficient and safe surgical margins are key to improving the survival rate and reducing the risk of relapse in LSCC patients.     

Preliminary proteomic analysis of human serum from patients with laryngeal carcinoma

To better evaluate the serum protein alterations in patients with laryngeal carcinoma during surgical treatment process, a comparative proteomic analysis of human serum from patients with laryngeal carcinoma between pre- and post-operation group was performed using two-dimensional gel electrophoresis, in combination with matrix-assisted laser desorption ionization time-of-flight mass spectrometry and database searching. Statistical analysis indicated that 16 gel spots corresponding to 12 proteins altered their expression significantly between the two groups of patients with laryngeal carcinoma. Of these 12 proteins, 6 proteins were up-regulated in the pre-operation group. The subsequent Western blot confirmed the results of proteome analysis. Measurement of MDA and SOD levels in serum combining with bioinformatics analysis indicated the potential roles of the oxidant stress and immune response as target in monitoring and treating laryngeal carcinoma. The study provides new insight into the laryngeal carcinoma development and treatment, and the identified proteins are warranted to be further studied.     

老龄喉癌喉部分切除术远期疗效观察

目的 探讨老龄喉癌患者行保留喉功能切除术的远期疗效。方法 总结１９８６￣１９９６年间９９例６５岁以上老龄喉癌患者行各种喉部分切降术的临床资料,其中声带切除４４例、垂直半喉切除３１例、声门上水平半喉切除１５例、声门水平切除２例、水平垂直（３／４）切除２２例、喉近全切除５例、喉全切除环咽吻合１０例。结果 术后全部病例均恢复了发音功能及吞咽功能,拔管率为９１．９％。术中无死亡,术后无严重并发症。３、５年     

喉癌切除后发音重建的临床研究

本文就1975年～1995年8月间收治的资料完整的95例喉癌手术方式、喉功能恢复及生存率进行分析。97．9％（93／95）的患者吞咽功能良好，80．0％（76／95）发音良好。部分喉切除拔管率为59.5％（22／37）。全喉切除术1、3、5年生存率分别为88.1％、82.4％、76．9％；部分喉切除术1、3、5年生存率分别为86．7％、78．3％、68.4％。按临床分期统计生存率：Ⅰ～Ⅱ期患者1、3、5年生存率为91．2％、83．3％、81．3％，Ⅲ～Ⅳ期患者1、3、5年生存率为84.6％、78．1％、69．2％。     

Survival of patients with laryngeal cancer and some prognostic factors

Tumour growth and its progression to a metastatic phenotype involves a serious of genetic events with abnormal activation of oncogenes or inactivation of tumour suppressor genes and others genes connected with proliferation, apoptosis and neovascularisation. The aims of the study were to determine the possible prognostic value of angiogenesis, proliferation index Ki67, p53 and bcl-2 proteins expression in patients with laryngeal cancer. The group of 151 patients with laryngeal cancer, surgically treated with minimum 5 years observation, was multi-variously analysed. Paraffin--embedded tissue sections from each case were stained with a monoclonal antibody raised against FVIII antigen, p53 and bcl-2 proteins and Ki67 proliferation antigen using a peroxidase labelled streptavidin--biotin kit in standard immunohistochemistry techniques. In univariate analysis: staging IV, tumour size T4, nodal metastasis N2 and N3, local and nodal recurrences, high expression of Ki67 and P53, high (over median) IA measured as number of microvessels with FVIII expression were significantly associated with shortened overall survival. Disease-free survival was related to: proliferation index Ki67, expression of P53 protein and angiogenesis measured as microvessels density with expression of FVIII antigen. In multivariate analysis the most important death risk factors for overall survival were: tumour size, nodal metastasis, local and nodal recurrences, P53 protein expression and IA measured as number of microvessels with FVIII expression. In multivariate analysis of disease-free survival only P53 protein expression, proliferative index Ki67 and expression of FVIII had independent prognostic value. Intensity of angiogenesis, proliferation index of Ki67 antigen and expression of P53 protein were independent predictors of patients with laryngeal cancer outcome. In contrary Bcl2 protein seems to be useless in these patients.