T3声门型喉鳞状细胞癌手术治疗效果及影响因素分析

目的:探讨T_(3)声门型喉癌患者行全喉切除术或部分喉切除术的临床效果及影响因素。方法:回顾性分析手术治疗的84例T_(3)声门型喉鳞状细胞癌患者的临床资料,包括性别、年龄、病理学分级、N分期、手术方式、手术切缘、术后放疗、术后咽喉部复发、术后颈部淋巴结复发,评估与喉癌预后的相关性;生存分析采用Kaplan-Meier法计算,单因素分析采用Log-rank检验或者χ^(2)检验,多因素分析采用Cox比例风险回归模型。结果:T_(3)声门型喉癌患者5年总体生存率为75.0%,10年总体生存率为64.7%;部分喉切除术患者5年生存率79.6%,全喉切除术患者5年生存率68.6%;单因素分析显示年龄、病理学分级、手术切缘、N分期、术后咽喉部复发、术后颈部淋巴结复发与T_(3)声门型喉癌的预后相关(P<0.05);多因素分析显示年龄、N分期、手术切缘、肿瘤复发是影响T_(3)声门型喉癌患者生存的独立危险因素(P<0.05)。结论:对于选择的T_(3)声门型喉癌患者,部分喉切除术在保留喉功能的同时可获得较好的肿瘤学效果;精确评估肿瘤范围,保证安全切缘,合理的颈清扫术及术后及时放疗可以提高患者的生存率。

Analysis of surgical treatment effect and influencing factors of T3 glottic laryngeal squamous cell carcinoma

Objective:To investigate the clinical effect and influencing factors of total laryngectomy or partial laryngectomy in T3 glottic carcinoma patients.Methods:The clinical data of 84 patients with T3 glottic laryngeal squamous cell carcinoma treated by surgery were analyzed retrospectively,including gender,age,pathological grade,N stage,operation mode,surgical margin,postoperative radiotherapy,postoperative throat recurrence and postoperative neck lymph node recurrence,and the correlation between them and the prognosis of laryngeal carcinoma was evaluated.Kaplan-Meier method was used for univariate analysis,Log-rank test or χ2 test was used for univariate analysis,and Cox proportional risk regression model was used for multivariate analysis.Results:The 5-year overall survival rate of glottic carcinoma patients was 75.0%,and the 10-year overall survival rate was 64.7%.The 5-year survival rate was 79.6% in partial laryngectomy and 68.6% in total laryngectomy.Univariate analysis showed that age,pathological grade,surgical margin,N stage,postoperative throat recurrence and postoperative neck lymph node recurrence were related to the prognosis of glottic carcinoma (P＜0.05).Multivariate analysis showed that age,N stage,surgical margin and tumor recurrence were independent risk factors affecting the survival of patients with glottic carcinoma (P＜0.05).Conclusion:For selected T3 glottic carcinoma patients,partial laryngectomy can obtain better oncological results while retaining laryngeal function.Accurate evaluation of tumor scope,safe margin,reasonable neck dissection and timely postoperative radiotherapy can improve the survival rate of patients.