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.

Clinical analysis of squamous cell carcinoma of the subglottis

Objective To investigate the clinical characteristics,pattern of lymph node metastasis,optimal management and relative prognostic factors of subglottic squamous cell carcinoma.Methods A retrospective review was conducted in 36 cases with subglottic squamous cell carcinoma from 1970 to 2005.TNM staging showed 6 patients with stage Ⅰ,9 stage Ⅱ,8 stage Ⅲ and 13 stage Ⅳ (AJCC 2010).Eight of these 36 cases were treated with radiotherapy alone,18 with surgery alone and 10 with surgery plus perioperative radiotherapy. The overall 5-year survival rate was estimated by the Kaplan-Meier method according to different clinical stages and treatments.Log-Rank analysis was used to identify the prognostic factors.Results The overall 5-year survival rate was 58.2％,and 5-year survival rates were 66.7％,66.7％,62.5％ and 30.8％ for patients with stage Ⅰ,Ⅱ,Ⅲ and Ⅳ,respectively,and the rates were 43.8％,66.7％ and 51.9％ for radiotherapy alone,surgery alone,surgery plus perioperative radiotherapy,respectively.The 5-year survival rate of patients with stage Ⅰ - Ⅲ was significantly higher than that of patients with stage Ⅳ ( x2 =3.955,P ＜ 0.05 ).Pathologically confirmed positive rate of cervical lymph node was 25.0％ (9/36),and the positive cervical lymph nodes were mainly distributed in level Ⅵ,followed by level Ⅱ.The 5-year survival rate of patients with negative cervical lymph node was significantly higher than that of patients with positive cervical lymph node ( x2 =6.466,P ＜ 0.05).Conclusions The prognosis of subglottic squamous cell carcinoma was relatively poor.Total laryngectomy was the the main therapeutic management,and only part of the early cases could be treated with radiotherapy alone or partial laryngectomy.For locally advanced cases,the typical neck dissection including level Ⅱ - Ⅳ and Ⅵ should be performed.