發(fā)布時(shí)間：2019-01-17 10:31

【摘要】：目的：探討術(shù)后放療、同步放化療等輔助治療對(duì)早晚期喉鱗癌患者預(yù)后的影響及影響其預(yù)后的相關(guān)因素，包括(1)患者自身因素：年齡、性別、術(shù)后KPS評(píng)分；(2)腫瘤因素：病理類型、腫瘤分化程度、腫瘤部位、臨床分期；(3)治療因素：術(shù)后治療方式、放射治療總劑量、術(shù)后治療距手術(shù)時(shí)間、以期找到影響喉癌術(shù)后患者生存的獨(dú)立預(yù)后因素，為今后更準(zhǔn)確判斷患者預(yù)后，選擇更科學(xué)、有效的治療方法提供依據(jù)。 方法：本研究屬于回顧性研究，回顧性分析2000年1月至2009年12月山西省腫瘤醫(yī)院放療中心收治的463例喉癌術(shù)后患者的臨床病例資料，患者治療模式為手術(shù)±放療±化療，無嚴(yán)重術(shù)后并發(fā)癥，，均獲病理診斷且彩超、CT、喉鏡等影像資料、隨訪資料完整。詳細(xì)分析患者自身因素、腫瘤因素及治療因素對(duì)預(yù)后的影響，找到影響生存的獨(dú)立預(yù)后因素。Kaplan-Meier法計(jì)算生存時(shí)間及生存率，Log-rank檢驗(yàn)進(jìn)行單因素分析，Cox比例風(fēng)險(xiǎn)模型、逐步回歸法進(jìn)行多因素分析。 結(jié)果：本組463例喉鱗癌患者術(shù)后的中位生存時(shí)間為59.97個(gè)月，2年和5年生存率分別為86.9%和50.1%，無瘤生存率為81%和43%。術(shù)后同步放化療較術(shù)后放療及單純手術(shù)可以明顯提高局部喉鱗癌術(shù)后患者的總生存率。單因素分析示：患者年齡、術(shù)后KPS評(píng)分、病理分期、腫瘤類型、放療距手術(shù)時(shí)間、放療劑量、治療方案是影響患者生存的重要因素。多因素分析顯示：年齡（χ2＝7.349，P=0.007）、腫瘤分型（χ2＝25.655，P=0.000）、治療方案（χ2＝15.231，P=0.000）及病理分期（χ2＝77.880，P=0.000）是影響喉癌術(shù)后患者生存的獨(dú)立因素。 結(jié)論：(1)早期喉鱗癌患者無論是單純放療或同步放化療均未能提高生存率，可暫不做輔助放化療。 (2)局部晚期喉鱗癌患者術(shù)后行同步放、化療較術(shù)后放療或單純手術(shù)總生存率明顯提高。 (3)影響喉癌術(shù)后患者的獨(dú)立預(yù)后因素為年齡、腫瘤分型、治療方案及病理分期是影響喉癌術(shù)后患者生存的獨(dú)立因素。其中年齡60歲、聲門型喉癌、高分化鱗癌、臨床分期較早（Ⅰ、Ⅱ期）、局部晚期喉鱗癌（Ⅲ期、Ⅳa期、Ⅳb期）術(shù)后同步放、化療患者長(zhǎng)期生存的有利因素。
[Abstract]:Objective: to investigate the influence of radiotherapy, concurrent radiotherapy and chemotherapy on the prognosis of patients with early and late laryngeal squamous cell carcinoma (LSCC), including (1) patients' own factors: age, sex, postoperative KPS score; (2) tumor factors: pathological type, tumor differentiation degree, tumor location, clinical stage; (3) Therapeutic factors: postoperative treatment mode, total dose of radiotherapy, time from postoperative treatment to operation, in order to find out the independent prognostic factors affecting the survival of patients with laryngeal cancer, and to judge the prognosis of patients more accurately and choose more scientifically in the future. The effective treatment method provides the basis. Methods: this study was a retrospective study. The clinical data of 463 patients with laryngeal carcinoma treated by radiotherapy Center of Shanxi Cancer Hospital from January 2000 to December 2009 were retrospectively analyzed. There were no serious postoperative complications, all were pathologically diagnosed, color Doppler ultrasound, CT, laryngoscope and other imaging data, the follow-up data were complete. The influence of patients' own factors, tumor factors and treatment factors on prognosis was analyzed in detail, and independent prognostic factors were found. Survival time and survival rate were calculated by Kaplan-Meier method, univariate analysis by Log-rank test and Cox proportional risk model. Stepwise regression analysis was carried out. Results: the median survival time of 463 patients with laryngeal squamous cell carcinoma was 59.97 months. The 2-year and 5-year survival rates were 86.9% and 50.1%, respectively. The tumor-free survival rate was 81% and 43%. The overall survival rate of patients with local laryngeal squamous cell carcinoma was significantly improved by simultaneous radiotherapy and chemotherapy compared with radiotherapy and surgery alone. Univariate analysis showed that age, postoperative KPS score, pathological stage, tumor type, radiotherapy distance from surgery, radiotherapy dose and treatment regimen were important factors affecting the survival of patients. Multivariate analysis showed that age (蠂 ~ 2 = 7.349), tumor type (蠂 ~ 2 = 25.655), treatment regimen (蠂 ~ 2 = 15.231) and pathological stage (蠂 ~ 2 = 77.880), respectively. P0. 000) is an independent factor affecting the survival of postoperative laryngeal cancer patients. Conclusion: (1) the survival rate of patients with early laryngeal squamous cell carcinoma was not improved by radiotherapy alone or concurrent radiotherapy and chemotherapy. (2) the overall survival rate of patients with locally advanced laryngeal squamous cell carcinoma (LSCC) was significantly higher than that of postoperative radiotherapy and chemotherapy. (3) the independent prognostic factors of laryngeal cancer patients were age, tumor type, treatment plan and pathological stage. Among them, 60 years old, glottic laryngeal carcinoma, well differentiated squamous cell carcinoma, early clinical stage (鈪

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