發(fā)布時間：2018-03-20 00:31

  本文選題：局部晚期下咽癌　切入點：預(yù)后　出處：《第二軍醫(yī)大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：【目的】分析總結(jié)局部晚期下咽癌的臨床病理特點,探討影響局部晚期下咽癌患者預(yù)后的相關(guān)因素,對不同治療方法進行療效分析,為局部晚期下咽癌的治療提供新的思路。【對象與方法】本研究的對象為2003年01月到2011年12月期間上海長海醫(yī)院耳鼻咽喉頭頸外科收治的局部晚期下咽鱗癌病例。課題研究分為兩部分。第一部分,根據(jù)以往累積資料的統(tǒng)計及檢索醫(yī)院病例數(shù)據(jù)庫,收集整理患者年齡、性別、煙酒史、病程時間、臨床表現(xiàn)、腫瘤的部位、病理分級、腫瘤分期、是否合并第二原發(fā)癌等相關(guān)臨床資料,并對患者的生存情況進行隨訪。根據(jù)Kaplan-Meier方法進行生存率的統(tǒng)計和單因素分析,并用Log-rank檢驗,采用Cox回歸模型進行多因素分析,得出影響患者預(yù)后的獨立因素。第二部分,在第一部分的基礎(chǔ)上,收集患者術(shù)前合并癥、原發(fā)灶及頸部淋巴結(jié)的處理方案、術(shù)后缺損的修復(fù)重建方式、術(shù)后并發(fā)癥等資料,將所有患者按照治療方法的不同進行分組,根據(jù)Kaplan-Meier方法進行生存率的統(tǒng)計,組間比較采用Log-rank檢驗,比較不同治療方法的療效。【結(jié)果】第一部分,本課題研究符合納入標(biāo)準(zhǔn)患者共328例,其中男性312例(95.1%),女性16例(4.9%),男女比例19.5:1,平均年齡59.7±8.7歲,長期煙酒史患者共217例,占66.2%。根據(jù)解剖亞區(qū)劃分,梨狀窩癌267例(81.4%),咽后壁癌41例(12.5%),環(huán)后癌20例(6.1%)。分化程度:高分化鱗癌70例,中分化鱗癌193例,低分化鱗癌65例,主要病理分級為中低分化鱗癌。TNM分期:T2期61例(18.6%),T3期212例(64.6%),T4a期52例(15.9%),T4b期3例(0.9%);NO期63例(19.2%),N1期72例(22.0%),N2a期18例(5.5%),N2b期103例(31.4%),N2c期64例(19.5%),N3期8例(2.4%);M0期328例(100%)。腫瘤分期:III期119例(36.3%),IVA期198例(60.4%),IVB期11例(3.3%)。所有患者中發(fā)生第二原發(fā)癌29例(8.8%)。Kaplan-Meier方法計算患者的3年、5年總體生存率(OS)分別為56.8%和41.3%。單因素分析腫瘤分期為影響患者預(yù)后的重要因素,Cox回歸模型多因素分析顯示影響患者預(yù)后的獨立因素為腫瘤分期(p0.05)。第二部分,根據(jù)不同治療方法將所有入組患者分為非手術(shù)治療組與手術(shù)治療組。非手術(shù)治療組中,男性患者68例(90.7%),女性患者7例(9.3%),平均年齡61.8±8.2歲。75例患者中,18例行單純根治性放療,8例放療后化療,13例TPF方案誘導(dǎo)化療后行放療,36例行同步放化療。手術(shù)治療組中,男性患者244例(96.4%),女性患者9例(3.6%),平均年齡59.1±8.7歲。所有手術(shù)患者均以根治性切除原發(fā)灶為基本原則,并且所有患者均行淋巴結(jié)清掃,單側(cè)頸部淋巴結(jié)清掃63例,雙側(cè)頸部淋巴結(jié)清掃190例,共清掃443側(cè),術(shù)后缺損采用喉及周圍粘膜、胸大肌皮瓣、前臂游離皮瓣、胃上提胃咽吻合術(shù)等進行修復(fù)重建。根據(jù)方案的不同,又將手術(shù)治療組分為單純手術(shù)組、術(shù)前放化療聯(lián)合手術(shù)組及手術(shù)聯(lián)合放化療組。采用Kaplan-Meier方法計算非手術(shù)治療組及手術(shù)治療組的3年總體生存率(OS)分別為39.8%、61.8%,5年總體生存率(OS)分別為28.0%、45.1%,經(jīng)過Log-rank檢驗,非手術(shù)治療組與手術(shù)治療組療效差異具有統(tǒng)計學(xué)意義(p0.05)。計算手術(shù)治療組中不同治療分組(單純手術(shù)組、術(shù)前放化療聯(lián)合手術(shù)組及手術(shù)聯(lián)合放化療組)的3年總體生存率(OS)分別為40.3%、60.2%、66.2%,5年生存率分別為20.1%、44.5%、46.7%,經(jīng)過Log-rank檢驗,三組治療方法之間療效差異具有統(tǒng)計學(xué)意義(p0.05),并且手術(shù)聯(lián)合放化療組與術(shù)前放化療聯(lián)合手術(shù)組療效優(yōu)于單純手術(shù)組�！窘Y(jié)論】:局部晚期下咽癌預(yù)后差。治療前應(yīng)完善相關(guān)檢查并進行嚴(yán)格的分期,這樣有利于對預(yù)后的判斷。手術(shù)患者,由于本身已屬晚期,存在高危因素,術(shù)后均應(yīng)采取輔助放化療,以提高手術(shù)患者的療效。非手術(shù)患者,可以根據(jù)患者的身體狀況采取同步放化療或誘導(dǎo)化療的方案。
[Abstract]:[Objective] analysis of clinical and pathological features of hypopharyngeal carcinoma summary of locally advanced, to investigate the effects of locally advanced factors related to the prognosis of hypopharyngeal cancer patients, the curative effect of different treatment methods, to provide new ideas for the treatment of locally advanced hypopharyngeal cancer. [method] with the object of this research is locally advanced in 2003 01 August to December 2011 Changhai Hospital of Shanghai otolaryngology head and neck surgery were hypopharyngeal squamous cell carcinoma cases. The study is divided into two parts. The first part, according to the statistical data and the previous cumulative hospital case retrieval database, collect the patient age, gender, smoking history, disease duration, clinical symptoms, tumor location, pathological grade, tumor stage, whether the merger of second primary cancer and other related clinical data and follow-up of patients' survival. According to Kaplan-Meier statistics of survival rate and single factor analysis, Using Log-rank test, Cox regression model was used for multivariate analysis, the independent prognostic factors. The second part, on the basis of the first part, collected from patients with preoperative complications of primary tumor and neck lymph node treatment, repair and reconstruction of defect after operation mode, data of complications after operation. All patients in accordance with the different methods of treatment group were statistical survival rate according to Kaplan-Meier method, were compared by Log-rank test, the effect of different treatment methods were compared. [results] the first part, this paper studies met the inclusion criteria of patients with a total of 328 cases, including 312 cases of male (95.1%), 16 females (4.9% 19.5:1), the proportion of men and women, mean age 59.7 + 8.7 years, a total of 217 cases of patients with long-term history of alcohol and tobacco, accounting for 66.2%. according to the anatomic sub division, pyriform sinus carcinoma in 267 cases (81.4%), 41 cases of pharyngeal cancer (12.5%), 20 cases (6.1%) after the ring. 鍖栫▼搴，

本文編號：1636735