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治疗对晚期喉癌患者生存率的影响。

The effect of treatment on survival in patients with advanced laryngeal carcinoma.

作者信息

Gourin Christine G, Conger Bryant T, Sheils W Chris, Bilodeau Paul A, Coleman Teresa A, Porubsky Edward S

机构信息

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.

出版信息

Laryngoscope. 2009 Jul;119(7):1312-7. doi: 10.1002/lary.20477.

Abstract

OBJECTIVES/HYPOTHESIS: Over the last 2 decades, survival from laryngeal cancer has decreased. We sought to identify factors associated with decreased survival in laryngeal cancer.

METHODS

Patients diagnosed with laryngeal squamous cell carcinoma from 1985 to 2002 were retrospectively reviewed.

RESULTS

A total of 451 patients met study criteria. Five-year survival rates were 85% for stage I, 77% for stage II, 51% for stage III, and 35% for stage IV disease. Survival for patients with stage I-III disease was similar for patients treated operatively or nonoperatively (P = .4). However, patients with stage III disease treated nonoperatively had worse survival with radiation alone (XRT) compared to chemoradiation (CR) (P = .006). Patients with stage IV disease had significantly better survival with surgery (49%) than CR (21%) or XRT alone (14%) (P < .0001). Analysis by primary tumor stage demonstrated that survival for T1-T3 disease was independent of treatment modality (P = .2); however, for T4 patients, operative treatment was associated with significantly better survival (55%) than CR (25%) or XRT (0%) (P < .0001). Proportional hazards models confirmed significantly worse survival for stage IV, T4, N2 or N3 disease, and nonoperative treatment. For T4 disease, after controlling for nodal status, nonoperative treatment was the only significant predictor of worse survival.

CONCLUSIONS

Primary surgical treatment is associated with improved survival for patients with stage IV disease and specifically T4 primary tumors. These data suggest that the observed national decrease in survival from laryngeal cancer may be due to a shift toward nonoperative treatment in that subset of patients with advanced primary disease.

摘要

目的/假设:在过去20年中,喉癌患者的生存率有所下降。我们试图确定与喉癌生存率下降相关的因素。

方法

对1985年至2002年期间诊断为喉鳞状细胞癌的患者进行回顾性研究。

结果

共有451例患者符合研究标准。I期患者的5年生存率为85%,II期为77%,III期为51%,IV期为35%。I - III期疾病患者接受手术或非手术治疗的生存率相似(P = 0.4)。然而,III期疾病患者单纯放疗(XRT)的生存率低于放化疗(CR)(P = 0.006)。IV期疾病患者手术治疗的生存率(49%)明显高于单纯CR(21%)或单纯XRT(14%)(P < 0.0001)。按原发肿瘤分期分析表明,T1 - T3期疾病的生存率与治疗方式无关(P = 0.2);然而,对于T4期患者,手术治疗的生存率(55%)明显高于CR(25%)或XRT(0%)(P < 0.0001)。比例风险模型证实,IV期、T4期、N2或N3期疾病以及非手术治疗患者的生存率明显较差。对于T4期疾病,在控制淋巴结状态后,非手术治疗是生存率较差的唯一显著预测因素。

结论

对于IV期疾病患者,尤其是T4期原发肿瘤患者,一期手术治疗可提高生存率。这些数据表明,全国范围内观察到的喉癌生存率下降可能是由于晚期原发疾病患者向非手术治疗的转变。

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