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[下咽原发性癌预后的变化趋势及原因分析:单中心2003 - 2007年与2010 - 2014年数据对比]

[Changing trend in prognosis of primary hypopharyngeal carcinoma and reason analysis: date comparison of 2003-2007 and 2010-2014 in a single centre].

作者信息

Tao L, Zhou L, Zhang M, Wu H T, Li X M, Chen X L, Li C, Xie M, Cheng L, Heng Y

机构信息

Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Feb 7;55(2):116-124. doi: 10.3760/cma.j.issn.1673-0860.2020.02.007.

Abstract

To explore changing trend in prognosis of primary hypopharyngeal carcinoma and to analyze the reasons at the Eye, Ear, Nose and Throat Hospital of Fudan University. We retrospectively analyzed the clinical data of 461 patients with primary hypopharyngeal carcinoma treated at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2003 to 2007 (Group 1) and 2010 to 2014 (Group 2) according to the inclusion criteria. 142 from Group 1, including 133 males and 9 females, rangedfrom 38 to 82 years old and 319 from Group 2, including 313 males and 6 females, ranged from 39 to 81 years old, were included in this work. The laryngeal function preservation rate, survival outcome, application and effect of pre-and post-operative adjuvant therapy were compared. SPSS 24.0 was used for statistical analyses. There were 62 patients with early disease (T1-2N0) including 18 in Group 1 and 44 in Group 2, in whom 3 (16.7%) underwent surgical procedures with laryngeal function preservation in Group 1, while, 30 (68.2%) underwent laryngeal function preservation surgery in Group 2. The laryngeal function preservation rate showed an obviously upward trend in recent years (χ(2)=13.617, 0.001), whereas, the recurrence-free survival rate (RFS) and overall survival rate (OS) showed no significant differences between two groups (0.469 and 0.808, respectively). Among the 399 patients with advanced disease, 124 were in Group 1 and 275 in Group 2. After propensity score matching (PSM) was used, the OS rate was significantly higher for Group 2 than Group 1 (0.017), while the application of laryngeal function preservation surgery was significantly higher in Group 2 (χ(2)=4.686, 0.030). The application rates of preoperative adjuvant therapy and postoperative adjuvant chemotherapy were significantly higher in group 2 than in group 1 (χ(2)=5.687, 0.017; χ(2)=19.407, 0.001). The application of laryngeal function preserving surgery significantly increases the retention rate of laryngeal functions in patients with early-stage hypopharyngeal carcinoma, with similar long-term survival outcomes. The application of comprehensive treatment including preoperative adjuvant therapy and postoperative adjuvant treatments, especially postoperative chemoradiotherapy, shows an obvious increase in the function preservation rate and long-term survival in patients with advanced hypopharyngeal carcinoma.

摘要

为探究原发性下咽癌预后的变化趋势并分析其原因,在复旦大学附属眼耳鼻喉科医院开展此项研究。我们根据纳入标准,回顾性分析了2003年至2007年(第1组)以及2010年至2014年(第2组)在复旦大学附属眼耳鼻喉科医院接受治疗的461例原发性下咽癌患者的临床资料。第1组142例,其中男性133例,女性9例,年龄38至82岁;第2组319例,其中男性313例,女性6例,年龄39至81岁,均纳入本研究。比较两组患者的喉功能保留率、生存结局以及术前和术后辅助治疗的应用情况及效果。采用SPSS 24.0进行统计学分析。早期病例(T1 - 2N0)共62例,其中第1组18例,第2组44例。第1组中3例(16.7%)接受了保留喉功能的手术,而第2组中30例(68.2%)接受了保留喉功能的手术。近年来喉功能保留率呈明显上升趋势(χ(2)=13.617,P = 0.001),而两组的无复发生存率(RFS)和总生存率(OS)无显著差异(分别为0.469和0.808)。在399例晚期病例中,第1组124例,第2组275例。采用倾向评分匹配(PSM)后,第2组的OS率显著高于第1组(P = 0.017),同时第2组保留喉功能手术的应用率显著更高(χ(2)=4.686,P = 0.030)。第2组术前辅助治疗和术后辅助化疗的应用率显著高于第1组(χ(2)=5.687,P = 0.017;χ(2)=19.407,P = 0.001)。保留喉功能手术的应用显著提高了早期下咽癌患者的喉功能保留率,且长期生存结局相似。包括术前辅助治疗和术后辅助治疗,尤其是术后放化疗在内的综合治疗的应用,显示晚期下咽癌患者的功能保留率和长期生存率明显提高。

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