本文選題：下咽癌　切入點(diǎn)：生存率　出處：《廣西醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的探討下咽鱗癌不同治療方式的療效及其生存分析,為下咽癌的治療提供更好的臨床依據(jù)。 方法回顧性研究1999年1月1日至2007年10月31日期間在廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院頭頸外科及放療科住院治療的83例下咽鱗癌患者。83例分為三個(gè)治療組,S+R組32例,S+R+C組27例,S+C組24例。83例中原發(fā)灶位于梨狀窩59例、咽后壁17例、環(huán)后7例;鱗癌Ⅰ、Ⅱ、Ⅲ級(jí)各為12例、28例、43例;臨床分期Ⅰ期10例、Ⅱ期21例、Ⅲ期12例、Ⅳ期40例。 下咽癌總體生存曲線采用Life Tables法,下咽癌預(yù)后各臨床因素的比較采用Kaplan-Meier法計(jì)算生存率,用log-rank檢驗(yàn)進(jìn)行生存曲線差異的比較,多因素分析采用Cox逐步回歸模型,計(jì)數(shù)資料用χ2檢驗(yàn)或確切概率法,檢驗(yàn)水準(zhǔn)α=P,以P㩳0.05為檢驗(yàn)有統(tǒng)計(jì)意義。 結(jié)果1.總體上三組3、5年生存率分別為53.0%、35.8%,三種治療方式的3、5年生存率不盡相同,其中S+R+C組最高,其次為S+R組,最低者為S+C組。S+R組、S+R+C組和S+C組的3年生存率分別為54.3%、65.4%、32.1%,5年生存率分別為37.3%、49.0%、4.6%,三種治療方式3、5年生存率組間差異P=0.001。 2.單因素分析治療方式的差異、頸部淋巴結(jié)轉(zhuǎn)移、T分期、N分期、臨床分期、病理分級(jí)為下咽癌預(yù)后相關(guān)因素,是否保留喉功能和原發(fā)灶不同與下咽癌預(yù)后無明顯關(guān)系。Cox多因素統(tǒng)計(jì)結(jié)果表明治療方式的差異、T分期、N分期、病理分級(jí)為下咽癌預(yù)后的獨(dú)立因素。 結(jié)論1.三種治療方式中以S+R+C組3、5年生存率最高,手術(shù)結(jié)合放療為主的治療方式能明顯提高下咽癌患者的生存率。S+R組和S+R+C組比S+C組更能提高患者3、5年生存率。S+R+C組比S+R組不能明顯提高下咽癌患者3、5年生存率。 2.治療方式的差異、T分期、N分期、病理分級(jí)可能為下咽癌預(yù)后的獨(dú)立因素。頸部淋巴結(jié)轉(zhuǎn)移、臨床分期可能為下咽癌預(yù)后的相關(guān)因素,但可能不是下咽癌預(yù)后的獨(dú)立因素。 3.下咽癌有較高的復(fù)發(fā)率和轉(zhuǎn)移率,如何降低下咽癌的復(fù)發(fā)率和轉(zhuǎn)移率,以及提高下咽癌復(fù)發(fā)和轉(zhuǎn)移后的治療生存率和生活質(zhì)量值得進(jìn)一步探討。
[Abstract]:Objective to explore the efficacy and survival analysis of different treatment methods for hypopharyngeal squamous cell carcinoma (scscc), and to provide a better clinical basis for the treatment of hypopharyngeal carcinoma.
Methods a retrospective study from January 1, 1999 to October 31, 2007 in head and neck surgery and radiation oncology Affiliated Hospital of Guangxi Medical University hospital treatment of 83 cases of hypopharyngeal squamous cell carcinoma patients with.83 were divided into three treatment groups, 32 cases in S+R group, 27 cases in S+R+C group, S+C group of 24 cases of.83 cases of primary lesions in the pyriform sinus in 59 cases, posterior the wall in 17 cases, 7 cases of squamous cell carcinoma after ring; I, II, III in 12 cases, 28 cases, 43 cases; 10 cases of clinical stage I and II in 21 cases, 12 cases of stage III, IV in 40 cases.
The overall survival curve of hypopharyngeal carcinoma by using Life Tables method, the prognosis of hypopharyngeal carcinoma with various clinical factors compared with Kaplan-Meier method to calculate the survival rate, compare the difference in survival curves with log-rank test, multivariate analysis using Cox regression model, 2 test or exact test was used to test the level of alpha count data, =P, P 0.05? For statistical significance test.
Results of the 1. overall three year survival rate of 3,5 group were 53%, 35.8%, three kinds of treatment methods 3,5 year survival rate is not the same, the S+R+C group was the highest, followed by the S+R group, the lowest in S+C group and.S+R group, 3 year survival rate of S+R+C group and S+C group were 54.3%, 65.4%, 32.1% and the 5 year survival rates were 37.3%, 49%, 4.6%, three year survival rate of 3,5 treatment group differences P=0.001.
2. single factor analysis of the differences in the treatments of cervical lymph node metastasis, T stage, N stage, clinical stage, pathological grading for hypopharyngeal cancer prognosis related factors, whether to keep the laryngeal function and primary hypopharyngeal carcinoma with different prognosis multivariate statistical results no significant relationship between.Cox showed differences in the treatment of T stage. N staging, pathological grading and independent prognostic factors for hypopharyngeal cancer prognosis.
1. three kinds of treatment conclusions in group S+R+C to 3,5 the highest survival rate, surgery combined with radiotherapy in treatment of hypopharyngeal cancer can significantly increase the survival rate of.S+R group and S+R+C group can improve the survival rate of.S+R+C patients in 3,5 group than in the S+R group can't significantly improve the hypopharyngeal cancer patient survival rate more than 3,5 S+C group.
2., the difference in treatment modalities, T stage, N stage and pathological grade may be independent prognostic factors for hypopharyngeal carcinoma. Cervical lymph node metastasis and clinical stage may be related factors for prognosis of hypopharyngeal carcinoma, but may not be an independent prognostic factor for hypopharyngeal carcinoma.
3. hypopharyngeal carcinoma has higher recurrence rate and metastasis rate. How to reduce the recurrence rate and metastasis rate of hypopharyngeal carcinoma and improve the survival rate and quality of life after recurrence and metastasis of hypopharyngeal carcinoma is worth further exploring.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R739.63

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