影响喉癌生存率的预后因素分析
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摘要
目的:探讨影响喉癌患者生存率的相关因素。方法:回顾性分析77例喉癌患者的临床资料,包括年龄、性别、吸烟、族别、肿瘤部位、病理学分级、T分期、N分期、临床分期和治疗方式。应用Kaplan-Mei-er进行生存分析,组间比较用log rank检验,多因素分析采用Cox比例风险模型。结果:总的1年、3年、5年生存率分别为98.7%、73.4%、54.1%。单因素分析提示肿瘤部位、病理学分级、T分期、N分期、临床分期、治疗方式均有统计学意义(P＜0.05);多因素分析发现肿瘤部位(P＜0.046)、病理学分级(P＜0.027)、临床分期(P＜0.030)、治疗方式(P＜0.009)对预后的影响有统计学意义。结论:影响喉癌预后的因素为肿瘤部位、病理学分级、T分期、N分期、临床分期、治疗方式;其中独立预后因素为肿瘤部位、病理学分级、临床分期、治疗方式。
Purpose:To investigate the factors affecting the survival rate of laryngeal carcinoma.Methods:Seventy-seven cases were analyzed retrospectively,including sex, age smoking,race,primary site.pathological grade,T-stage,N-stage,clinical stage, treatment methods.Survival analysis was performed by Kaplan-Meier method; comparison among/between groups was performed using log rank test;multivariate analysis was carried out using Cox proportional hazard model.Results:Overall 1-,3-and 5- year survival rates were 98.7%,73.4%and 54.1%.Univariate analysis showed that primary site,pathological grade,T-stage,N-stage,clinical stage and treatment methods were proven to significant(P＜0.05).Multivariate analysis showed the prognosis statistically correlated with primary site(P＜0.046),pathological grade(P＜0.027),clinical stage(P＜0.030)and treatment methods(P＜0.009).Conclusion:The factors affecting the prognosis of the patients with laryngeal carcinoma are primary site,pathological type, T-stage,N-stage,clinical stage and treatment methods;the independent prognostic factors are primary site,pathological type,clinical stage and treatment methods.
Purpose:To investigate the factors affecting the survival rate of laryngeal carcinoma.Methods:Seventy-seven cases were analyzed retrospectively,including sex, age smoking,race,primary site.pathological grade,T-stage,N-stage,clinical stage, treatment methods.Survival analysis was performed by Kaplan-Meier method; comparison among/between groups was performed using log rank test;multivariate analysis was carried out using Cox proportional hazard model.Results:Overall 1-,3-and 5- year survival rates were 98.7%,73.4%and 54.1%.Univariate analysis showed that primary site,pathological grade,T-stage,N-stage,clinical stage and treatment methods were proven to significant(P＜0.05).Multivariate analysis showed the prognosis statistically correlated with primary site(P＜0.046),pathological grade(P＜0.027),clinical stage(P＜0.030)and treatment methods(P＜0.009).Conclusion:The factors affecting the prognosis of the patients with laryngeal carcinoma are primary site,pathological type, T-stage,N-stage,clinical stage and treatment methods;the independent prognostic factors are primary site,pathological type,clinical stage and treatment methods.
引文
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[25]Spriano G,Piantanida R,Pellini R,et al.Elective treatment of the neck in squamous cell carcinoma of the larynx:clinical experience[J].Head Neck,2003,25(5):97-102
[26]Buckley J G,Maclerman K.Cervical node metastases in laryngeal and hypolaryngeal cancer:a prospective analysis of prevalence and distribution[J].Head Neck,2000,22(4):380-385
[27]Yang C Y,Andersen P E,Everts E C,et al.Nodal disease in purely glottic carcinoma:is elective neck treatment worthwhile?[J].Laryngoscope,1998,108(4):1006-1008
[28]Spector G J,Sessions D G,Lenox J,et al.Management of stage Ⅳ glottic carcinoma:therapeutic outcomes[J].Laryngoscope,2004,114(7):1438-1446
[29]Sessions D G,Lenox J,Spector G J,et al.Management of T3NOM0 glottic carcinoma:therapeutic outcomes[J].Laryngoscope,2002,112(7 Pt 1):1281-1288
[30]屠规益,徐国镇.头颈恶性肿瘤的规范性治疗[M].北京:人民卫生出版社,2003: 175-176
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[32]Cortesina G,De-Stefani A,Cavalot A,et al.Current role of radiotherapy in the treatment of locally advanced laryngeal carcinoma[J].J Surg Oncol,2000.74(1):79-82
[33]Ambrosch P,Kron M,Pradier O,et al.Efficacy of selective neck dissection:A review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract[J].Otolaryngol Head Neck Surg,2001,124(2):180-187
[34]Smeele LE,Leemans C R,Langendijk J K.et al.Positive surgical margins in neck dissection specimens in patients with head and neck squamous cell carcinoma and the effect of radiotherapy[J].Head Neck,2000,22(6):559-563
[35]郭朱明,曾宗渊,陈福进,等.喉鳞癌治疗后原发灶复发的相关因素分析[J].癌症,2002.21(10):1087-1082
[36]曾宗渊,陈福进,张诠,等.手术加放射治疗与单纯喉部分切除术治疗喉癌的疗效比较[J].中华耳鼻咽喉科杂志,2000,35(1):32-34
[37]黄选兆,汪吉宝主编.实用耳鼻咽喉科学[M].北京:人民卫生出版社,2005:502-508
[38]韩德民主编.喉癌-治疗与康复[M].北京:人民卫生出版社.2003:134-135
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[7]杜强,季文越,关超,等.手术切除治疗喉癌的预后因素分析[J].中华肿瘤杂志,2006,28(3):211-213
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[26]Nguyen-Tan PF,Le QT,Quivey JM,et al.Treatment results and prognostic factors of advanced T3-4 laryngeal carcinoma:the University of California,San Francisco (UCSF)and Stanford University Hospital(SUH)experience[J].Int J Radiat Oncol Biol Phys 2001,50(5):1172-1180
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[31]Nicolai P,Redaelli de Zinis LO,Tomenzoli D,er al.Prognostic determinants in supraglottic carcinoma:univariate and Cox regression analysis[J].Head Neck,1997,19:323-334
[2]田勇泉主编.耳鼻咽喉科学[M].第五版.北京:人民卫生出版,2001:200-204
[3]屠规益.现代头颈肿瘤外科学[M].科学出版社.2004:3-5
[4]Jose J,Coatesworth A P,Johnston C,et al.Cervical node metastases in squamous cell carcinoma of the upper aerodigestive tract:the significance of extracapsular spread and soft tissue deposits[J].Head Neck,2003,25(6):451-456
[5]Spector GJ.Distant metastases from laryngeal and hypopharyngeal cancer[J].ORL J Otorhinolaryngol Relat Spec,2001,63:224-228
[6]Spector JG,Sessions DG,Haughey BH,et al.Delayed regional metastases,distant metastases,and second primary malignancies in squamous cell carcinomas of the larynx and hypopharynx[J].Laryngoscope,2001,111:1079-1087
[7]Yucel OT,Yilmaz T,Unal OF,et al.Distant metastases in laryngeal squamous cell carcinoma[J].J Exp Clin Cancer Res,1999,18:285-288
[8]Jose J,Coatesworth A P,Johnston C,et al.Cervical node metastases in squamous cell carcinoma of the upper aerodigestive tract:the significance of extracapsular spread and soft tissue deposits[J].Head Neck,2003,25(6):451-456
[9]Nicolai P,Zinis LO,Tomenzoli D,et al.Prognostic determinants in supraglottic carcinoma:univariate and Cox regression analysis[J].Head Neck,1997,19:323-334
[10]Shvero J,Hader T,Feinmesser R,et al.Laryngeal carcinoma in females[J].Eur J Surg Oncol,1996,22(1):61-64
[11]夏良平,曾宗渊,魏茂文,等.影响喉癌生存率的单因素和多因素分析[J].中国肿瘤,2002,11(11):655-657
[12]Stell PM.Prognosis in laryngeal carcinoma.Host factors[J].Clin Otolaryngol,1990,15(2):111-119
[13]曾宗渊.实用头颈肿瘤学[M].广州:华南理工大学出版社,1996:295
[14]Crosignani P,Russo A,Tagliabue G,et al.Tobacco and diet as determinants of survival in male laryngeal cancer patients[J].Int J Cancer,1996,65(3):308-313
[15]Danic D,Maruic M,Uzarevic B,et al.Prognostic factors in squamous cell carcinoma of the larynx[J].ORL J Otorhinolaryngol Relat Spec,2000,62(3):143-148
[16]Nguyen-Tan PF,Le QT,Quivey JM,et al.Treatment results and prognostic factors of advanced T3-4 laryngeal carcinoma:the University of California,San Francisco (UCSF)and Stanford University Hospital(SUH)experience[J].Int J Radiat Oncol Biol Phys,2001,50(5):1172-1180
[17]佟凯,屠规益.声门上型喉癌颈部淋巴结转移N1的处理与转移[J].中华耳鼻咽喉科杂志,1996,31(50):307
[18]Redaelli de Zinis L O,Nicolai P,Tomenzoli D,et al.The distribution of lymph node metastases in supraglottic squamous cell carcinoma:therapeutic implications[J].Head Neck,2002,24:913-920
[19]McGavran,M.D.Walter C.The incidence of cervical lymph node metastasis from Epidermoid Carcinoma of the laryrnx[J].Cancer,2000,14:55-66
[20]张荣强,张艳芳,任重.声门上型喉癌肿瘤生物学特性与双侧颈淋巴结转移关系的研究[J].耳鼻咽喉头颈外科,2002,9(3):154-157
[21]Pragier R,Gonzalez A,Matos E,et al.Prognosis factors in laryngeal Carcinoma[J].Cancer,1993,71:2472-2476
[22]Myers EN,Alvi A.Magenement of carcinoma of the supraglottic larynx:evolution,current concepts,and future trends[J].Laryngoscope,1996,106(5pt1):559-567
[23]张乃嵩,韩多吉,贾深汕.声门上型喉癌临床颈淋巴结阴性患者颈清扫区域的选择[J].中华耳鼻咽喉科杂志,2002,37(2):83
[24]Luca O,Piero N,Davide T,et al.the distribution of lymph node metastases in supraglottic squamous cell carcinoma:therapeutic implication[J].Head Neck,2002,24(10):913
[25]Spriano G,Piantanida R,Pellini R,et al.Elective treatment of the neck in squamous cell carcinoma of the larynx:clinical experience[J].Head Neck,2003,25(5):97-102
[26]Buckley J G,Maclerman K.Cervical node metastases in laryngeal and hypolaryngeal cancer:a prospective analysis of prevalence and distribution[J].Head Neck,2000,22(4):380-385
[27]Yang C Y,Andersen P E,Everts E C,et al.Nodal disease in purely glottic carcinoma:is elective neck treatment worthwhile?[J].Laryngoscope,1998,108(4):1006-1008
[28]Spector G J,Sessions D G,Lenox J,et al.Management of stage Ⅳ glottic carcinoma:therapeutic outcomes[J].Laryngoscope,2004,114(7):1438-1446
[29]Sessions D G,Lenox J,Spector G J,et al.Management of T3NOM0 glottic carcinoma:therapeutic outcomes[J].Laryngoscope,2002,112(7 Pt 1):1281-1288
[30]屠规益,徐国镇.头颈恶性肿瘤的规范性治疗[M].北京:人民卫生出版社,2003: 175-176
[31]Jose J,Coatesworth A P,Johnston C,et al.Cervical node metastasis in squamous cell carcinoma of the upper aerodigestive tract:the significance of extracapsular spread and soft tissue[J].Head Neck,2003,25(6):451-456
[32]Cortesina G,De-Stefani A,Cavalot A,et al.Current role of radiotherapy in the treatment of locally advanced laryngeal carcinoma[J].J Surg Oncol,2000.74(1):79-82
[33]Ambrosch P,Kron M,Pradier O,et al.Efficacy of selective neck dissection:A review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract[J].Otolaryngol Head Neck Surg,2001,124(2):180-187
[34]Smeele LE,Leemans C R,Langendijk J K.et al.Positive surgical margins in neck dissection specimens in patients with head and neck squamous cell carcinoma and the effect of radiotherapy[J].Head Neck,2000,22(6):559-563
[35]郭朱明,曾宗渊,陈福进,等.喉鳞癌治疗后原发灶复发的相关因素分析[J].癌症,2002.21(10):1087-1082
[36]曾宗渊,陈福进,张诠,等.手术加放射治疗与单纯喉部分切除术治疗喉癌的疗效比较[J].中华耳鼻咽喉科杂志,2000,35(1):32-34
[37]黄选兆,汪吉宝主编.实用耳鼻咽喉科学[M].北京:人民卫生出版社,2005:502-508
[38]韩德民主编.喉癌-治疗与康复[M].北京:人民卫生出版社.2003:134-135
[1]Magnano M,De Stefani A,Usai A,et al.Carcinoma of the larynx in the elderly:analysis of potentially significant prognostic variables[J].Aging,1999,11(5):316-322
[2]夏良平,曾宗渊,魏茂文,等.影响喉癌生存率的单因素和多因素分析[J].中国肿瘤,2002,11(11):655-657
[3]Shvero J,Hader T,Feinmesser R,et al.Laryngeal carcinoma in females[J].Eur J Surg Oncol,1996,22(1):61-64
[4]Hoffmann D,Hoffmann I,EL Bayoumy K.The less harmful cigarette:a controversial issue,a tribute to Ernst L.Wynder.Chem Res Toxicol,2001,14(7):767-790
[5]Ryberg D,Skaug V,Hewer A,et al.Genotypes of glutathione transferase M1 and P1and their significance for lung DNA adduct levels and cancer risk[J].Carcinogenesis,1997,18(7):1285-1289
[6]Crosignani P,Russo A,Tagliabue G,et al.Tobacco and diet as determinants of survival in male laryngeal cancer patients[J].Int J Cancer,1996,65(3):308-313
[7]杜强,季文越,关超,等.手术切除治疗喉癌的预后因素分析[J].中华肿瘤杂志,2006,28(3):211-213
[8]Yilmaz T,Hosal AS,Gedikoglu G,et al.Prognostic significance of vascular and perineural invasion in cancer of the larynx[J].AmJ Otolaryngol,1998,19(2):83-88
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