喉癌的远处转移和相关因素分析

目的 分析与喉癌远处转移显著相关的因素。方法 回顾1990～1995年于中山大学肿瘤防治中心住院治疗的277例喉癌患者，对随访中18例出现远处转移的患者进行总结，明确喉癌远处转移的发生率、发生部位、时间以及预后情况。同时应用单因素Kaplan—Meier和多因素Cox模型分析277例喉癌远处转移的相关因素。结果 喉癌远处转移的发生率为6．5％(18／277)，肺转移占83．3％(15／18)，肝转移16．7％(3／18)，3例肺转移合并骨转移(其中椎骨1例，肋骨1例，以及多发性骨转移者1例)。2例初诊入院时即发现远处转移，其余患者从初诊入院治疗到发现远处转移的时间间隔为1～103个月，间隔中位时间为7个月。喉癌远处转移患者的3年和5年累计生存率分别为23．8％和11．9％。出现远处转移距死亡的间隔时间介于2～77个月，间隔中位时间为4．6个月。喉癌出现肝转移的预后最差，最长仅为4．6个月。对277例喉癌进行单因素Kaplan—Meier分析显示病理诊断、鳞状细胞癌病理分化程度、N分期以及临床分期是影响喉癌远处转移的显著因素。多因素Cox模型分析仅有N分期是喉癌远处转移的显著因素(Wald=7．889，P=0．005)。结论 喉癌存在一定比率的远处转移，主要发生在肺，而且预后很差。非鳞状细胞癌的其他恶性肿瘤、低分化鳞状细胞癌、颈淋巴结转移和临床晚期都可能影响喉癌的远处转移，但只有颈部N分期对喉癌远处转移具有显著的预测价值。

Distant metastases and their significant indicators in laryngeal cancer]

OBJECTIVE: To investigate the factors on distant metastases (DM) of laryngeal cancer. METHODS: 277 cases of laryngeal cancer hospitalized in Cancer Center of Sun Yat-sen University from 1990 to 1995 were reviewed. 18 cases with DM were investigated to confirm the distant metastatic rate, target organ, time interval, and prognosis. Kaplan-Meier and Cox model analysis were used to find the significant indicators for DM in laryngeal cancer. RESULTS: The overall incidence of DM in laryngeal cancer was 6.5% (18/277). The target site of DM was mainly in lung 83.3% (15/18), liver 16.7% (3/18). 3 cases with DM in lung also combined with bone metastases which occurred in vertebra 1, lib 1 and 1 in multi-sites. 2 patients were diagnosed DM when admitted, and the rest with time interval between 1 and 103 months (median 7 months). The 3-year and 5-year cumulative survival in laryngeal cancer with DM was 23.8% and 11.9% respectively. The time interval between the presentation of DM and death was 2.77 months (median 4.6 months). The worst prognosis is liver metastasis with which the patient could survive 4.6 months at most in our study. Kaplan-Meier analysis in 277 laryngeal cancers showed that pathology, pathological differentiation of squamous cell carcinoma, N stage, and clinical stage were significant indicators for DM from laryngeal cancer. Cox model analysis showed that only N stage was the significant prognostic factor for DM in laryngeal cancer (Wald = 7.889, P = 0.005). CONCLUSION: Laryngeal cancer has certain percentage of DM, which is mainly in lung and their prognosis is usually poor. Non-squamous cell carcinoma, low pathological differentiation, cervical metastasis and advanced cancer are the possible indicators for DM, but our study shows that only N stage significantly predicts DM from laryngeal cancer.