Tsou Yung An, Hua Jun Hong, Lin Meng Hung, Tsai Ming Hsui
Department of Otolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan, ROC.
ORL J Otorhinolaryngol Relat Spec. 2006;68(4):206-12. doi: 10.1159/000091803. Epub 2006 Feb 28.
Not all patients with hypopharyngeal cancer who undergo concurrent chemoradiation therapy have a good prognosis. We hope to find the significant prognostic factors that could help us in patient selection for concurrent chemoradiation therapy.
We used a retrospective analysis on several prognostic factors which may affect the treatment outcome and prognosis.
We studied 51 patients with stage III-IV hypopharyngeal cancer who underwent chemoradiation therapy as the first treatment method. Possible significant prognostic factors (i.e. tumor volume, central necrosis, pathology, age) were collected to determine whether they correlate with local disease control and survival.
Primary tumor volume correlated with local disease control and survival. The greatest risk for local failure was found among patients with primary tumor volumes >19.0 ml (p = 0.001). Other relatively significant prognostic factors were pathology and central necrosis. The survival rate among patients with primary tumor volumes >19.0 ml was only 39.3% compared with 78.3% for patients with volumes <19.0 ml (p = 0.036). A proportional hazard model indicated that significant parameters associated with overall survival were primary tumor volume (p = 0.036) and central necrosis (p = 0.008). According to the cancer cell differentiation, the hazard risk in the well-differentiated group was 5.62 folds higher than in the poorly differentiated group (p = 0.05). Patients with an initial complete response had a primary tumor volume <19 ml (p = 0.001, 0.016), poorly differentiated pathology (p = 0.001, 0.016), and no central necrosis (p = 0.001, 0.016). Other relatively poor significant factors were T stage above III (p = 0.047), cervical lymphadenopathy beyond level II (p = 0.046), and a nodal volume >10.0 ml (p = 0.029). N stage, age and gender were not significant prognostic factors.
Tumor volume is the most important prognostic factor of treatment outcome for patients with hypopharyngeal cancer and should always be taken into consideration in treatment planning. Other possible prognostic factors which affect the initial complete response rate and survival rate including central necrosis, pathology, nodal number and nodal volume, T stage above III, and cervical lymphadenopathy beyond level II have a relatively low correlation with treatment outcome. In our study, there was a correlation between tumor volume and central necrosis, but no significant correlation between pathological differentiation and tumor volume, although both affect treatment outcome.
并非所有接受同步放化疗的下咽癌患者预后都良好。我们希望找到能帮助我们选择同步放化疗患者的重要预后因素。
我们对可能影响治疗结果和预后的几个预后因素进行了回顾性分析。
我们研究了51例III - IV期下咽癌患者，他们接受放化疗作为首选治疗方法。收集可能的重要预后因素（即肿瘤体积、中心坏死、病理、年龄）以确定它们是否与局部疾病控制和生存率相关。
原发肿瘤体积与局部疾病控制和生存率相关。原发肿瘤体积>19.0 ml的患者局部失败风险最高（p = 0.001）。其他相对重要的预后因素是病理和中心坏死。原发肿瘤体积>19.0 ml的患者生存率仅为39.3%，而体积<19.0 ml的患者为78.3%（p = 0.036）。比例风险模型表明，与总生存相关的显著参数是原发肿瘤体积（p = 0.036）和中心坏死（p = 0.008）。根据癌细胞分化情况，高分化组的风险比低分化组高5.62倍（p = 0.05）。初始完全缓解的患者原发肿瘤体积<19 ml（p = 0.001，0.016）、病理低分化（p = 0.001，0.016）且无中心坏死（p = 0.001，0.016）。其他相对较差的显著因素是T分期高于III期（p = 0.047）、颈部淋巴结转移超过II区（p = 0.046）以及淋巴结体积>10.0 ml（p = 0.029）。N分期、年龄和性别不是显著的预后因素。
肿瘤体积是下咽癌患者治疗结果最重要的预后因素，在治疗规划中应始终予以考虑。其他可能影响初始完全缓解率和生存率的预后因素，包括中心坏死、病理、淋巴结数量和体积、T分期高于III期以及颈部淋巴结转移超过II区，与治疗结果的相关性相对较低。在我们的研究中，肿瘤体积与中心坏死之间存在相关性，但病理分化与肿瘤体积之间无显著相关性，尽管两者均影响治疗结果。
