本文關鍵詞： 下咽癌 治療 生存分析 生存率　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的分析影響下咽癌患者總生存時間及無進展生存時間的危險因素,以期為臨床治療提供參考。方法回顧分析吉林大學第二醫(yī)院耳鼻咽喉頭-頸外科及放療科自2008年1月1日至2016年3月1日期間所收治的病例資料完整且病理證實為下咽鱗狀細胞癌的97例患者。將97例患者根據(jù)治療方式不同分為4組,分別為單純手術組(Surgery,S)29例,手術+放療組(Surgery+Radiotherapy,SR)32例,單純放療組(Radiotherapy,R)8例和同步放化療組(Concurrent chemoradiotherapy,CCR)28例,統(tǒng)計患者性別、年齡、腫瘤原發(fā)灶位置、TNM分期、臨床分期、治療方式、病理分化程度等臨床資料,用Kaplan-Meier法及Log Rank檢驗分析上述因素與總生存時間(Overall Survival,OS)、無進展生存生存時間(Progression-Free Survival,FPS)的關系,運用Cox逐步回歸模型進行多因素生存分析,p0.05認為有統(tǒng)計學意義,即為獨立危險因素,并繪制生存曲線。結果1.臨床資料:全組97例下咽癌患者,男93例,女4例,平均年齡(57.1±7.9)歲;既往有抽煙及飲酒史者分別占總數(shù)的85.6%及89.7%;腫瘤原發(fā)灶位置:梨狀窩型76例(78.4%),咽后壁型13例(13.4%),環(huán)后型8例(8.2%);腫瘤TNM分期:T1-T2期共51例(52.6%),T3-T4期共46例(47.4%),N0期20例(20.6%),N1期41例(42.3%),N2-N3期36例(37.1%);臨床分期:Ⅰ期-Ⅱ期11例(11.3%),Ⅲ期-Ⅳ期86例(88.7%);病理分化程度:原位癌4例(4.1%),高分化鱗狀細胞癌20例(20.6%),中分化鱗狀細胞癌65例(67.0%),低分化鱗狀細胞癌8例(8.3%)。2.生存分析:全組患者的1年、3年、5年總生存率分別為91.8%、55.6%和39.9%,無進展生存率分別為73.6%、25.4%、3.2%;治療方式是總生存時間(p=0.002)及無進展生存時的危險因素(p=0.003),但并非獨立危險因素;影響總生存時間的獨立危險因素為N分期(p=0.001);影響無進展生存時間的獨立危險因素為N分期(p=0.000)及年齡分組(p=0.013)。結論1.下咽癌是一種臨床發(fā)病率較低、病程進展隱匿、手術復雜、預后差的惡性腫瘤。2.約50%的下咽癌患者發(fā)病年齡為51~60歲,男性患者顯著多于女性,且患者多有長期(20年)抽煙及飲酒史。3.腫瘤患者的生存時間與頸淋巴結轉移情況顯著相關,因治療方式并非影響生存時間的獨立危險因素,故治療前需詳細檢查并綜合分析。4.對于早期下咽癌患者,治療可采用單純手術治療或放療,而對于晚期可切除病變患者可采用以手術為主的綜合治療,不推薦給予高齡患者過度激進性的治療。
[Abstract]:Objective to analyze the risk factors affecting the total survival time and progression free survival time of patients with hypopharyngeal carcinoma. Methods the data of patients in Department of Otorhinolaryngology and head and neck surgery and radiotherapy from January 1st 2008 to March 1st 2016 were analyzed retrospectively. 97 patients with hypopharyngeal squamous cell carcinoma confirmed by pathology were divided into 4 groups according to different treatment methods. There were 29 cases of Surgerysma in the simple operation group and 32 cases of surgery radiotherapysma in the radiotherapy group. There were 8 cases of radiotherapysmal RV in radiotherapy alone group and 28 cases of concurrent chemotherapy group (concurrent chemotherapy group). Gender, age, tumor location, TNM staging, clinical staging, treatment, pathological differentiation and other clinical data were statistically analyzed. Kaplan-Meier method and Log Rank test were used to analyze the above factors and total survival time. The relationship between Progression-Free Survival (FPS) and Progression-Free Survival (FPS) was analyzed by Cox stepwise regression model. Results 1. Clinical data: 97 patients with hypopharyngeal carcinoma, 93 males and 4 females. The average age was 57.1 鹵7.9 years. 85.6% and 89.7of the patients had a history of smoking and drinking respectively. The location of primary tumor was: Pyriform fossa type (76 cases), posterior pharyngeal wall type (13 cases), posterior wall type (13 cases) and posterior ring type (8 cases). There were 51 cases with TNM: T1-T2 stage and 46 cases with T3-T4 stage. There were 20 cases with N0 stage and 20 cases with T3-T4 stage. There were 41 cases with N1 stage and 36 cases with N2-N3 stage. Clinical staging: stage 鈪，

本文編號：1475622