下咽鳞状细胞癌根治术后患者随访分析及生活质量调查
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摘要
目的分析下咽鳞状细胞癌根治术后患者的生存情况及生活质量。方法回顾性分析首都医科大学附属北京同仁医院耳鼻咽喉头颈外科2011年1月至2015年6月住院下咽鳞状细胞癌患者194例临床资料。使用欧洲癌症研究与治疗组织针对头颈肿瘤患者的生命质量测定量表(EORTC-QLQ-H&N35)对患者生活质量进行评估。使用Kaplan-Meier方法分析患者术后3年生存情况。结果 194例患者中,接受不保留喉功能切除术69例(35. 6%),保留喉功能切除术125例(64. 4%)。不保留喉功能患者术后3年病死率为50. 7%(35/69),保留喉功能患者术后3年病死率为23. 2%(29/125),保留喉功能组生存情况优于不保留喉功能组(χ~2=15. 520,P <0. 001)。EORTC-QLQ-H&N35评估患者生活质量可见,术后3、12个月时,患者吞咽功能、语言功能、饮食情况、社会接触得分较术前变化差异均有统计学意义(均P <0. 05),术后3个月时患者生活质量最差。结论下咽鳞状细胞癌术后患者3年生存率较低,患者生活质量较术前明显降低,今后关注生存率的同时更应提高患者生活质量。
Objective To investigate the survival condition and quality of life in patients with hypopharyngeal squamous cell carcinoma after radical resection. Methods Clinical data of 194 cases of hypopharyngeal squamous cell carcinoma who had surgical treatment at Beijing Tongren Hospital,Capital Medical University from January2011 to June 2015 were retrospectively analyzed. Quality of life was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire( EORTC-QLQ-H&N35). Kaplan-Meier method was used to analyze the survival data during 3-year follow-up. Results Among the 194 patients,69 patients( 35. 6%) underwent laryngectomy without laryngeal function preservation and the 3-year death rate was50. 7%( 35/69); 125 patients( 64. 4%) underwent laryngectomy with laryngeal function preservation and the3-year death rate was 23. 2%( 29/125). Patients with laryngeal function preservation showed a high survival( χ~2=15. 520,P < 0. 001). At 3 and 12 months after operation,EORTC-QLQ-H&N35 scores of swallowing function,language function,dietary status and social contact were worse than those before operation( P < 0. 05) and it showed the worst quality of life at 3 months. Conclusion The 3-year survival condition of patients with hypopharyngeal squamous cell carcinoma resection is poor; quality of life decreases significantly after operation.
Objective To investigate the survival condition and quality of life in patients with hypopharyngeal squamous cell carcinoma after radical resection. Methods Clinical data of 194 cases of hypopharyngeal squamous cell carcinoma who had surgical treatment at Beijing Tongren Hospital,Capital Medical University from January2011 to June 2015 were retrospectively analyzed. Quality of life was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire( EORTC-QLQ-H&N35). Kaplan-Meier method was used to analyze the survival data during 3-year follow-up. Results Among the 194 patients,69 patients( 35. 6%) underwent laryngectomy without laryngeal function preservation and the 3-year death rate was50. 7%( 35/69); 125 patients( 64. 4%) underwent laryngectomy with laryngeal function preservation and the3-year death rate was 23. 2%( 29/125). Patients with laryngeal function preservation showed a high survival( χ~2=15. 520,P < 0. 001). At 3 and 12 months after operation,EORTC-QLQ-H&N35 scores of swallowing function,language function,dietary status and social contact were worse than those before operation( P < 0. 05) and it showed the worst quality of life at 3 months. Conclusion The 3-year survival condition of patients with hypopharyngeal squamous cell carcinoma resection is poor; quality of life decreases significantly after operation.
引文
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[14]刘义森,刘业海,吴开乐,等.老年下咽癌喉功能保留手术[J].临床耳鼻咽喉头颈外科杂志,2014,28(14):1034-1037.DOI:10.13201/j.issn.1001-1781.2014.14.007.Liu YS,Liu YH,Wu KL,et al.Laryngeal function preserving surgery in elderly hypopharygeal carcinoma[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2014,28(14):1034-1037.DOI:10.13201/j.issn.1001-1781.2014.14.007.
[15]曾镇罡,肖水芳,赵恩民,等.喉功能保留的下咽癌外科治疗[J].中华耳鼻咽喉头颈外科杂志,2014,49(7):539-542.DOI:10.3760/cma.j.issn.1673-0860.2014.07.003.Zeng ZG,Xiao SF,Zhao EM,et al.Surgical treatment for advanced carcinoma of hypopharynx and laryngeal function preservation[J].Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2014,49(7):539-542.DOI:10.3760/cma.j.issn.1673-0860.2014.07.003.
[16]Park YM,Jung CM,Cha D,et al.The long-term oncological and functional outcomes of transoral robotic surgery in patients with hypopharyngeal cancer[J].Oral Oncology,2017(71):138-143.DOI:10.1016/j.oraloncology.2017.06.016.
[17]邱志利,蒋晓平.喉癌下咽癌术后咽瘘发生的危险因素分析[J].检验医学与临床,2015,12(12):1728-1729,1732.DOI:10.3969/j.issn.1672-9455.2015.12.027.Qiu ZL,Jiang XP.Multivariate analysis of risk factors of pharyngocutaneous fistula after surgery for larynx and hyperpharynx cancer[J].Laboratory Medicine and Clinic,2015,12(12):1728-1729,1732.DOI:10.3969/j.issn.1672-9455.2015.12.027.
[18]唐正中,陶振超,吴爱东,等.下咽癌患者生存率的影响因素分析[J].安徽医科大学学报,2013,48(7):843-845.DOI:10.19405/j.cnki.issn1000-1492.2013.07.035.Tang ZZ,Tao ZC,Wu AD,et al.Analysis of the long-term survival rates and influence factors for hypopharyngeal carcinoma[J].Acta Universitatis Medicinalis Anhui,2013,48(7):843-845.DOI:10.19405/j.cnki.issn1000-1492.2013.07.035.
[19]耿志洋,郑宏良.局部晚期下咽癌的治疗进展[J].临床耳鼻咽喉头颈外科杂志,2017,31(9):732-736.DOI:10.13201/j.issn.1001-1781.2017.09.024.Geng ZY,Zheng HL.Progress in the treatment of locally advanced hypopharyngeal carcinoma[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2017,31(9):732-736.DOI:10.13201/j.issn.1001-1781.2017.09.024.
[20]Cousins N,Macaulay F,Lang H,et al.A systematic review of interventions for eating and drinking problems following treatment for head and neck cancer suggests a need to look beyond swallowing and trismus[J].Oral Oncology,2013,49(5):387-400.DOI:10.1016/j.oraloncology.2012.12.002.
[21]周梁.口咽癌诊断与治疗发展现状[J].中国耳鼻咽喉头颈外科,2017,24(11):582-585.DOI:10.16066/j.1672-7002.2017.11.007.Zhou L.Current status of diagnosis and treatment of oropharyngeal carcinoma[J].Chinese Archives of Otolaryngology-Head and Neck Surgery,2017,24(11):582-585.DOI:10.16066/j.1672-7002.2017.11.007.
[22]鲁旭飞,陶匀雅,童磊,等.舌癌患者术后生存质量与相关影响因素的研究[J].中国临床医生杂志,2017,45(5):27-30.DOI:10.3969/j.issn.2095-8552.2017.05.009.Lu XF,Tao YY,Tong L,et al.The analysis of factors affecting the quality of life of tongue cancer after primary surgery[J].Chinese Journal for Clinicians,2017,45(5):27-30.DOI:10.3969/j.issn.2095-8552.2017.05.009.
[2]Petersen JF,Timmermans AJ,van Dijk BAC,et al.Trends in treatment,incidence and survival of hypopharynx cancer:a20-year population-based study in the Netherlands[J].Eur Arch Otorhinolaryngol,2018,275(1):181-189.DOI:10.1007/s00405-017-4766-6.
[3]Chu K,Fung K,Winquist E,et al.Comparison of swallowing quality of life measures in advanced larynx and hypopharynx cancer[J].Int J Radiat Oncol Biol Phys,2008,72(1):S501-502.DOI:10.1016/j.ijrobp.2008.06.1465
[4]O'Sullivan B,Shah JP.Head and neck cancer staging and prognosis:perspectives of the UICC and the AJCC//Head and neck cancer[M].New York:Springer,2016:135-155.
[5]中华耳鼻咽喉头颈外科杂志编辑委员会头颈外科组,中华医学会耳鼻咽喉头颈外科学分会头颈外科学组.下咽癌外科手术及综合治疗专家共识[J].中华耳鼻咽喉头颈外科杂志,2017,52(1):16-24.DOI:10.3760/cma.j.issn.1673-0860.2017.01.004.Head and Neck Surgery Group of Editorial Board of Chinese Journal of Otorhinolaryngology Head and neck surgery,Head and Neck Surgery Group,Society of Otorhinolaryngology Head and Neck Surgery,Chinese Medical Association.Expert consensus on surgery and comprehensive treatment of hypopharyngeal carcinoma[J].Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2017,52(1):16-24.DOI:10.3760/cma.j.issn.1673-0860.2017.01.004.
[6]Bjordal K,de Graeff A,Fayers PM,et al.A 12 country field study of the EORTC QLQ-C30(version 3.0)and the head and neck cancer specific module(EORTC QLQ-H&N35)in head and neck patients.EORTC Quality of Life Group[J].Eur J Cancer,2000,36(14):1796-1807.DOI:10.1016/S0959-8049(00)00186-6.
[7]曹轶倓,周梁,吴海涛,等.下咽癌386例临床特征及疗效分析[J].中华耳鼻咽喉头颈外科杂志,2016,51(6):433-439.DOI:10.3760/cma.j.issn.1673-0860.2016.06.007.Cao YT,Zhou L,Wu HT,et al.The clinical characteristics and treatment outcomes of 386 patients with hypopharyngeal cancer[J].Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2016,51(6):433-439.DOI:10.3760/cma.j.issn.1673-0860.2016.06.007.
[8]朱长雨,顾梅,党受涛,等.鼻咽癌肝转移研究进展[J].中国医药,2017,12(3):471-475.DOI:10.3760/cma.j.issn.1673-4777.2017.03.036.Zhu CY,Gu M,Dang ST,et al.Research progress of nasopharyngeal carcinoma with liver metastasis[J].China Medicine,2017,12(3):471-475.DOI:10.3760/cma.j.issn.1673-4777.2017.03.036.
[9]杜晶静,郭星,王琰,等.下咽癌的手术治疗及预后分析[J].现代肿瘤医学,2017,25(2):202-206.DOI:10.3969/j.issn.1672-4992.2017.02.010.Du JJ,Guo X,Wang Y,et al.Analysis of hypopharyngeal carcinoma operation treatment and prognosis[J].Journal of Modern Oncology,2017,25(2):202-206.DOI:10.3969/j.issn.1672-4992.2017.02.010.
[10]Kuo P,Sosa JA,Burtness BA,et al.Treatment trends and survival effects of chemotherapy for hypopharyngeal cancer:analysis of the National Cancer Data Base[J].Cancer,2016,122(12):1853-1860.DOI:10.1002/cncr.29962.
[11]黄家军,周小柳,李智群,等.外科手术治疗老年喉癌效果的影响因素分析[J].中国煤炭工业医学杂志,2015,18(9):1518-1521.DOI:10.11723/mtgyyx 1007-9564 201509022.Huang JJ,Zhou XL,Li ZQ,et al.Influence factors of surgical operation effect in treatment of elderly patients with laryngeal cancer[J].Chinese Journal of Coal Industry Medicine,2015,18(9):1518-1521.DOI:10.11723/mtgyyx 1007-9564 201509022.
[12]单冰菊,王爱英,王一越.复方三维B对鼻咽癌患者放疗期间营养风险和生活质量的影响[J].中国煤炭工业医学杂志,2017,20(3):355-357.DOI:10.11723/mtgyyx 1007-9564 201703028.Shan BJ,Wang AY,Wang YY.Effect of compound three-dimensional b on nutritional risk and quality of life in patients with nasopharyngeal carcinoma during radiotherapy[J].Chinese Journal of Coal Industry Medicine,2017,20(3):355-357.DOI:10.11723/mtgyyx 1007-9564 201703028.
[13]钱洁,朱江.下咽癌的临床治疗策略[J].临床耳鼻咽喉头颈外科杂志,2017,31(21):1701-1704.DOI:10.13201/j.issn.1001-1781.2017.21.021.Qian J,Zhu J.Clinical treatment strategy for hypopharyngeal carcinoma[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2017,31(21):1701-1704.DOI:10.13201/j.issn.1001-1781.2017.21.021.
[14]刘义森,刘业海,吴开乐,等.老年下咽癌喉功能保留手术[J].临床耳鼻咽喉头颈外科杂志,2014,28(14):1034-1037.DOI:10.13201/j.issn.1001-1781.2014.14.007.Liu YS,Liu YH,Wu KL,et al.Laryngeal function preserving surgery in elderly hypopharygeal carcinoma[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2014,28(14):1034-1037.DOI:10.13201/j.issn.1001-1781.2014.14.007.
[15]曾镇罡,肖水芳,赵恩民,等.喉功能保留的下咽癌外科治疗[J].中华耳鼻咽喉头颈外科杂志,2014,49(7):539-542.DOI:10.3760/cma.j.issn.1673-0860.2014.07.003.Zeng ZG,Xiao SF,Zhao EM,et al.Surgical treatment for advanced carcinoma of hypopharynx and laryngeal function preservation[J].Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2014,49(7):539-542.DOI:10.3760/cma.j.issn.1673-0860.2014.07.003.
[16]Park YM,Jung CM,Cha D,et al.The long-term oncological and functional outcomes of transoral robotic surgery in patients with hypopharyngeal cancer[J].Oral Oncology,2017(71):138-143.DOI:10.1016/j.oraloncology.2017.06.016.
[17]邱志利,蒋晓平.喉癌下咽癌术后咽瘘发生的危险因素分析[J].检验医学与临床,2015,12(12):1728-1729,1732.DOI:10.3969/j.issn.1672-9455.2015.12.027.Qiu ZL,Jiang XP.Multivariate analysis of risk factors of pharyngocutaneous fistula after surgery for larynx and hyperpharynx cancer[J].Laboratory Medicine and Clinic,2015,12(12):1728-1729,1732.DOI:10.3969/j.issn.1672-9455.2015.12.027.
[18]唐正中,陶振超,吴爱东,等.下咽癌患者生存率的影响因素分析[J].安徽医科大学学报,2013,48(7):843-845.DOI:10.19405/j.cnki.issn1000-1492.2013.07.035.Tang ZZ,Tao ZC,Wu AD,et al.Analysis of the long-term survival rates and influence factors for hypopharyngeal carcinoma[J].Acta Universitatis Medicinalis Anhui,2013,48(7):843-845.DOI:10.19405/j.cnki.issn1000-1492.2013.07.035.
[19]耿志洋,郑宏良.局部晚期下咽癌的治疗进展[J].临床耳鼻咽喉头颈外科杂志,2017,31(9):732-736.DOI:10.13201/j.issn.1001-1781.2017.09.024.Geng ZY,Zheng HL.Progress in the treatment of locally advanced hypopharyngeal carcinoma[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2017,31(9):732-736.DOI:10.13201/j.issn.1001-1781.2017.09.024.
[20]Cousins N,Macaulay F,Lang H,et al.A systematic review of interventions for eating and drinking problems following treatment for head and neck cancer suggests a need to look beyond swallowing and trismus[J].Oral Oncology,2013,49(5):387-400.DOI:10.1016/j.oraloncology.2012.12.002.
[21]周梁.口咽癌诊断与治疗发展现状[J].中国耳鼻咽喉头颈外科,2017,24(11):582-585.DOI:10.16066/j.1672-7002.2017.11.007.Zhou L.Current status of diagnosis and treatment of oropharyngeal carcinoma[J].Chinese Archives of Otolaryngology-Head and Neck Surgery,2017,24(11):582-585.DOI:10.16066/j.1672-7002.2017.11.007.
[22]鲁旭飞,陶匀雅,童磊,等.舌癌患者术后生存质量与相关影响因素的研究[J].中国临床医生杂志,2017,45(5):27-30.DOI:10.3969/j.issn.2095-8552.2017.05.009.Lu XF,Tao YY,Tong L,et al.The analysis of factors affecting the quality of life of tongue cancer after primary surgery[J].Chinese Journal for Clinicians,2017,45(5):27-30.DOI:10.3969/j.issn.2095-8552.2017.05.009.
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