202例Ⅲ～Ⅳ期喉鳞癌治疗方法评价及生存分析

背景与目的:喉鳞癌是头颈部常见的恶性肿瘤,Ⅰ～Ⅱ期喉鳞癌经手术或放疗后一般有较好的疗效,但Ⅲ～Ⅳ期喉鳞癌的疗效和预后尚不能令人满意,治疗方法也颇多争议,本研究着重探讨Ⅲ～Ⅳ期喉鳞癌不同治疗方法的疗效,比较各组生存率、未控复发情况,探索更合理的处理方法。方法:对中山大学肿瘤防治中心1991年1月～2000年1月间收治的202例Ⅲ～Ⅳ期喉鳞癌按治疗方法分为单纯手术组64例、手术 放射治疗组83例、放疗组41例和化疗组14例,进行回顾性研究,采用SPSS10.0寿命表法计算生存率,组间生存曲线比较采用Wilcoxon(Gehan)法,各组未控复发情况比较采用χ2检验。结果:Ⅲ～Ⅳ期喉鳞癌的5年累积生存率(42.12±3.62)%,10年累积生存率(33.20±4.32)%,中位生存时间48.5月;其中声门型喉鳞癌的5年累积生存率61.07%,声门上型喉鳞癌的5年累积生存率26.07%;单纯手术组的5年生存率53.41%,手术 放疗组51.04%,放疗组18.33%,化疗组7.14%;对比喉鳞癌单纯手术组和手术 放疗组的5年累积生存率,无论是Ⅲ期还是Ⅳ期,均无统计学意义(P>0.05);167例接受原发灶手术治疗,其中喉部分切除术31例,5年生存率56.15%,无复发;喉全切除术116例,5年生存率52.08%,复发11例。结论:Ⅲ～Ⅳ期喉鳞癌治疗以手术为主,全喉切除术仍是Ⅲ～Ⅳ期喉鳞癌治疗的主要手段,选择部分喉鳞癌病例可行部分喉切除术,不会增加原发灶复发的几率,也不会降低5年生存率。如术后可疑肿瘤残留或切缘阳性等则有术后放疗的必要,而其他病例术后一般不必放疗。

Treatment and prognosis of stage III-IV laryngeal squamous cell carcinoma

BACKGROUND & OBJECTIVE: Laryngeal squamous cell carcinoma (LSCC) is a common malignancy of the head and neck. Stage I-II LSCC patients have a favorable prognosis after operation or radiotherapy, but the curative effect and prognosis of stage III-IV LSCC are not satisfying, and its treatment is also controversial. This study was to summarize our experience in treating stage III-IV LSCC patients, evaluate the treatment results, and seek more reasonable therapeutic modality. METHODS: Records of 202 stage III-IV LSCC patients, treated in Cancer Center of Sun Yat-sen University from Jan. 1, 1991 to Jan. 1, 2000, were retrospectively analyzed. Of the 202 patients, 64 received surgery alone, 83 received surgery and preoperative or postoperative radiotherapy, 41 received radiotherapy, and 14 received chemotherapy. The overall survival rate was estimated using life table method by SPSS10.0 software. Survival curves were compared with Wilcoxon method; relapse statuses were compared with Chi(2) test. RESULTS: The 5- and 10-year overall survival rates of the 202 patients was (42.12+/-3.62)% and (33.20+/-4.32)%, and the median survival time was 48.5 months. The 5-year survival rates were 61.07% in glottic carcinoma group and 26.07% in supraglottic carcinoma group, and were 53.41% in surgery alone group, 51.04% in surgery plus radiotherapy group, 18.33% in radiotherapy group and 7.14% in chemotherapy group. There was no significant difference between surgery alone group and surgery plus radiotherapy group (P>0.05). Of the 147 patients received surgery, the 5-year survival rates were 56.15% for the 31 patients received partial laryngectomy and 52.08% for the 116 patients received total laryngectomy. Eleven patients had tumor relapsed after total laryngectomy within 5 years. CONCLUSIONS: Surgery, especially total laryngectomy, is the major treatment modality for stage III-IV LSCC. Partial laryngectomy may be performed with strict selection. Postoperative radiotherapy may be preformed on the patients with suspect of tumor residue or positive margin.