CAJ | 학술논문

目的回顾性分析扁桃体癌的治疗疗效,并探讨影响扁桃体癌的预后因素.方法 1997年4月至2008年4月中山大学肿瘤防治中心共收治经病理证实、无远处转移的扁桃体癌61例,其中末分化癌2例,低分化鳞癌26例,中高分化鳞癌33例.根据AJCC2002年第6版分期标准,Ⅰ期9例,Ⅱ期7例,Ⅲ期23例,Ⅳ期22例.27例患者行单纯放疗,23例行放疗联合化疗,6例行手术联合术后放疗,诱导化疗加手术联合术后放疗3例,放疗后外科挽救加化疗2例.结果随访率为96.7%.Kaplan-Metier方法计算全组5年总生存率为50.2%.16例Ⅰ-Ⅱ期患者中,8例行单纯放疗,5年生存率为50.0%,6例行手术联合术后放疗,5年生存率为83.3%,二者差异无统计学意义(P=0.318).45例Ⅲ-Ⅳ期患者,单纯放疗19例,5年生存率为51.5%,放疗联合化疗21例,5年生存率为36.4%,手术联合放疗为主的治疗5例,5年生存率为75.0%,三者差异无统计学意义(P=0.239).T1-T4期5年生存率分别为91.8%、46.8%、29.1%、0%(χ~2=30.168,P<0.001).Cox多因素分析显示T分期、治疗结束时原发灶和颈部转移淋巴结疗效为影响预后的独立危险因素(P<0.05).结论局部早期(Ⅰ-Ⅱ期)扁桃体癌的治疗,基于器官功能保全原则,倾向于选择单纯放疗,局部晚期(Ⅲ-Ⅳ期)扁桃体癌的治疗模式与疗效的关系仍需进一步研究.T分期、治疗结束时原发灶和颈部转移淋巴结疗效为影响预后的独立危险因素.
목적 회고성분석편도체암적치료료효,병탐토영향편도체암적예후인소.방법 1997년4월지2008년4월중산대학종류방치중심공수치경병리증실、무원처전이적편도체암61례,기중말분화암2례,저분화린암26례,중고분화린암33례.근거AJCC2002년제6판분기표준,Ⅰ기9례,Ⅱ기7례,Ⅲ기23례,Ⅳ기22례.27례환자행단순방료,23례행방료연합화료,6례행수술연합술후방료,유도화료가수술연합술후방료3례,방료후외과만구가화료2례.결과 수방솔위96.7%.Kaplan-Metier방법 계산전조5년총생존솔위50.2%.16례Ⅰ-Ⅱ기환자중,8례행단순방료,5년생존솔위50.0%,6례행수술연합술후방료,5년생존솔위83.3%,이자차이무통계학의의(P=0.318).45례Ⅲ-Ⅳ기환자,단순방료19례,5년생존솔위51.5%,방료연합화료21례,5년생존솔위36.4%,수술연합방료위주적치료5례,5년생존솔위75.0%,삼자차이무통계학의의(P=0.239).T1-T4기5년생존솔분별위91.8%、46.8%、29.1%、0%(χ~2=30.168,P<0.001).Cox다인소분석현시T분기、치료결속시원발조화경부전이림파결료효위영향예후적독립위험인소(P<0.05).결론 국부조기(Ⅰ-Ⅱ기)편도체암적치료,기우기관공능보전원칙,경향우선택단순방료,국부만기(Ⅲ-Ⅳ기)편도체암적치료모식여료효적관계잉수진일보연구.T분기、치료결속시원발조화경부전이림파결료효위영향예후적독립위험인소.
Objective To retrospectively analyze the therapeutic effect on patients with tonsillar carcinoma and factors affecting their prognosi. Methods Clinical data of 61 patients pathologically confirmed with tonsillar carcinoma without distant metastasis were analyzed. All the patients were treated in Cancer Center of Sun Yat-sen University from April 1997 to April 2008. There were 2 patients with undifferentiated carcinoma, 26 with poorly differentiated squamous cell carcinoma and 33 with median-well differentiated squamous cell carcinoma. According to the AJCC 2002 staging criteria for head-neck cancers, there were 9 staged Ⅰ cases, 7 staged Ⅱ cases,23 staged Ⅲ cases and 22 staged Ⅳ cases. The treatment was radiotherapy alone in 27 cases, radiotherapy combined with chemotherapy in 23 cases, surgery combined with postoperative radiotherapy in 6 cases, neoadjuvant chemotherapy plus surgery combined with postoperative radiotherapy in 3 cases, radiotherapy with salvage surgery in 2 cases. Results The overall 5-year survival rate was 50. 2%. For 16 cases with staged Ⅰ-Ⅱ staged, there were 8 cases with radiotherapy alone, 5 years survival was 50. 0%, 6 cases with surgery combined with postoperative radiotherapy, 5 years survival was 83.3%. The difference between the two treatments was not significant in statistics (P=0.318). For Ⅲ-Ⅳ staged 45 cases, there were 19 cases with simple radiotherapy, 5 years survival was 51.5%, 21 cases with radiotherapy combined with chemotherapy, 5 years survival was 36.4%, 5 cases with surgery combined with postoperative radiotherapy, 5 years survival was 75.0%. The difference among the three treatments was not significant in statistics (P=0.239). According to T stages, the 5-year survival rates of stage T1-T4 cases were 91.8%, 46.8%, 29.1%, 0% respectively (χ~2=30.168, P<0.001). Multivariate analysis demonstrated that T stage, therapeutic effect of primary site and cervical metastatic lymph node were the independent prognostic factors (P<0.05). Conclusions T stage, the therapeutic effect of primary site and cervical metastatic lymph node were the independent prognostic factors. For Ⅰ-Ⅱ staged tonsillar tumor cases, based on organ preservation, were tendency to choice simple radiotherapy. For Ⅲ-Ⅳ staged cases,yet the ralationships between therapeutic mode and therapeutic effect still need further researches.