舌鳞癌颈淋巴结复发患者挽救治疗的预后分析

目的　探讨舌鳞癌颈部淋巴结复发患者的临床特点及挽救治疗的预后影响因素。方法　回顾分析1988年1月至1999年8月在中山大学肿瘤防治中心行挽救治疗的舌鳞癌颈部淋巴结复发患者的临床病理资料,生存分析用Kaplan Meier法,组间比较用Log rank检验。结果　共42例颈部淋巴结复发患者行挽救治疗,挽救治疗后的3年,5年生存率分别是3 3 .3 % ,2 3 .2 %。影响挽救治疗生存率的预后因素为:原发肿瘤的临床分期、复发颈部淋巴结分期(rN分期)和挽救治疗方法。原发肿瘤临床分期为Ⅰ、Ⅱ期者预后较Ⅲ、Ⅳ期好(P <0 .0 5 ) ;复发颈部淋巴结分期为rN 1期者预后好于rN 2、rN 3期者好(P <0 .0 5 ) ;以手术或以手术为主综合治疗者的预后好于放化疗挽救治疗者(P <0 .0 5 )。62 %的患者在确诊为复发时,其颈部淋巴结的分期已届中晚期(rN 2、rN 3期)。结论　舌鳞癌颈部淋巴结复发患者的挽救治疗效果不佳,生存率低,复发的早期诊断及采用手术或以手术为主的综合挽救治疗有助于提高挽救生存率。

Prognostic Analysis of Salvage Treatment for Neck Recurrence of Oral Tongue Squamous Cell Carcinoma

Objective To study the clinical features of neck recurrent squamous cell carcinoma of oral tongue(SCCOT) and the prognostic factors after salvage treatment.Methods SCCOT patients with neck recurrence who received salvage treatment in Cancer Center,Sun Yat-sen University between 1988 and 1999 were retrospectively analyzed.Survival analysis was performed by Kaplan-Meier method and the Log-rank test was used to compare survival between groups.Results Forty-two patients who developed neck recurrent SCCOT received salvage treatment.The 3-year and 5-year survival rate after salvage treatment were 33.3% and 23.2%,respectively.The factors that associated with salvage survival rate were primary tumor stage,recurrent node stage(rN stage) and salvage treatment.Patients with an earlier primary tumor stage and rN stage and patients who received surgical treatment as their salvage modality had a better salvage survival rate(P<0.05).While most patients(62%) were at advanced rN stage(rN2?rN3) when they were diagnosed recurrence.Conclusion The salvage survival rate of neck recurrent SCCOT is poor.Early diognosis of neck recurrence and surgical salvage treatment may improve the salvage survival rate.