[晚期下咽鳞状细胞癌诱导化疗及后续综合治疗的单臂前瞻性研究：单中心260例报告]
[A single-arm prospective study on induction chemotherapy and subsequent comprehensive therapy for advanced hypopharyngeal squamous cell carcinoma: report of 260 cases in a single center].
作者信息
Yang Y F, Wang R, Fang J G, Zhong Q, Huang Z G, Chen X H, Zhang S R, Gao J M, Li S L, Li P D, Hou L Z, Chen X J, Ma H Z, Feng L, Zhang Y, He S Z, Lian M, Liu S Z
机构信息
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Department of Oncology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
出版信息
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Dec 7;55(12):1143-1153. doi: 10.3760/cma.j.cn115330-20200417-00306.
To study the significance of induction chemotherapy and subsequent comprehensive therapy for overall survival rate (OS) and larynx dysfunction-free survival rate (LDFS) in patients with advanced hypopharyngeal carcinoma. Patients who met the inclusion criteria with the diagnoses of advanced hypopharyngeal carcinoma between 2011 and 2017 received 2 or 3 cycles of TPF regimen induction chemotherapy. Patients who attained complete response (CR) received radical chemotherapy. Patients who attained partial response (PR) and the reduction of tumor volume was more than 70% were defined as large PR and received concurrent chemoradiotherapy. When the tumor volume reduction of PR patients was less than 70%, they were defined as small PR. (CR+large PR) group was defined as effective group. Patients who did not reach CR and large PR were defined as uneffective group and underwent radical surgery and received adjuvant radiotherapy as appropriate after the surgery. The end points of the study were OS, progression-free survival (PFS) and LDFS. Chi-square (χ(2)) test was used for correlation analysis. Survival analysis was performed by the Kaplan-Meier method with a test. Cox proportional hazards model was used for univariate and multivariate survival analysis. A total of 260 patients were enrolled in the study. The follow-up period ranged from 5 to 83 months, with an average of 24.7 months. The 3-year and 5-year OS rate was 46.0% and 32.6%, respectively. The 3-year and 5-year PFS rate was 41.0% and 26.6%, respectively. The 3-year and 5-year LDFS rate was 37.9% and 24.8%, respectively. Poor outcome of induction chemotherapy, advanced N stage, strong positive Ki-67 immunohistochemistry (all <0.001) were negative prognostic factors. The advanced clinical stage was positively related to the poor outcome of induction chemotherapy (=0.015). There was no significant difference in OS and PFS between the large PR group and the small PR group (all 0.005). TPF regimen induction chemotherapy and subsequent comprehensive therapy for patients with advanced hypopharyngeal carcinoma may improve the quality of life of patients, with high OS rate and LDFS rate.
研究诱导化疗及后续综合治疗对晚期下咽癌患者总生存率（OS）和无喉功能障碍生存率（LDFS）的意义。2011年至2017年间符合纳入标准且诊断为晚期下咽癌的患者接受2或3周期的TPF方案诱导化疗。达到完全缓解（CR）的患者接受根治性化疗。达到部分缓解（PR）且肿瘤体积缩小超过70%的患者定义为大PR，接受同步放化疗。当PR患者的肿瘤体积缩小小于70%时，定义为小PR。（CR + 大PR）组定义为有效组。未达到CR和大PR的患者定义为无效组，接受根治性手术，并在术后酌情接受辅助放疗。研究的终点为OS、无进展生存期（PFS）和LDFS。采用卡方（χ(2)）检验进行相关性分析。采用Kaplan-Meier法进行生存分析并进行检验。采用Cox比例风险模型进行单因素和多因素生存分析。本研究共纳入260例患者。随访时间为5至83个月，平均24.7个月。3年和5年OS率分别为46.0%和32.6%。3年和5年PFS率分别为41.0%和26.6%。3年和5年LDFS率分别为37.9%和24.8%。诱导化疗效果差、N分期晚、Ki-67免疫组化强阳性（均<0.001）为阴性预后因素。临床分期晚与诱导化疗效果差呈正相关（=0.015）。大PR组和小PR组的OS和PFS无显著差异（均>0.005）。TPF方案诱导化疗及后续综合治疗对晚期下咽癌患者可能改善患者生活质量，具有较高的OS率和LDFS率。
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