CAJ | 학술논문

目的：探讨影响新疆132例舌体鳞状细胞癌（ TSCC）患者预后的因素。方法病例为新疆医科大学第一附属医院2003年1月至2011年12月经病理确诊且随访资料完整的132例初治TSCC患者，其中24例未手术，108例手术（94例行颈部淋巴结清扫）；根据治疗方式分为单纯手术治疗29例，单纯放疗10例及综合治疗93例。随访患者生存情况并采用Kaplan-Meier 法进行生存分析，分析不同临床病理参数（性别、民族、年龄、分化程度、T分期、N分期、TNM分期、侵犯舌根、侵犯中线、侵犯口底及局部复发）及治疗方式（原发灶手术、放疗、化疗、颈部淋巴结清扫及手术情况）的5年生存率，同时采用Cox回归模型分析影响预后的独立因素。结果132例患者共随访5～120个月，9例失访，随访率为93?2％。61例生存，死亡62例，其中58例死于肿瘤相关疾病。132例患者的中位生存期为80?0个月，5年生存率为59?8％。临床病理参数中不同分化程度、T分期、N分期、TNM分期、是否侵犯中线、侵犯口底和局部复发及不同治疗方式中的是否为原发灶手术、放疗、颈部淋巴结清扫和手术情况的5年生存率差异有统计学意义（ P＜0?05）。多因素分析显示，分化程度、局部复发、原发灶手术、TNM分期和放疗是影响TSCC预后的独立因素。结论原发灶彻底手术、合理颈部淋巴结清扫及预防局部复发能够改善TSCC患者的预后。早期TSCC建议首选手术治疗，而中晚期首选以手术为主的综合治疗，术后放疗的疗效较好。
목적：탐토영향신강132례설체린상세포암（ TSCC）환자예후적인소。방법병례위신강의과대학제일부속의원2003년1월지2011년12월경병리학진차수방자료완정적132례초치TSCC환자，기중24례미수술，108례수술（94례행경부림파결청소）；근거치료방식분위단순수술치료29례，단순방료10례급종합치료93례。수방환자생존정황병채용Kaplan-Meier 법진행생존분석，분석불동림상병리삼수（성별、민족、년령、분화정도、T분기、N분기、TNM분기、침범설근、침범중선、침범구저급국부복발）급치료방식（원발조수술、방료、화료、경부림파결청소급수술정황）적5년생존솔，동시채용Cox회귀모형분석영향예후적독립인소。결과132례환자공수방5～120개월，9례실방，수방솔위93?2％。61례생존，사망62례，기중58례사우종류상관질병。132례환자적중위생존기위80?0개월，5년생존솔위59?8％。림상병리삼수중불동분화정도、T분기、N분기、TNM분기、시부침범중선、침범구저화국부복발급불동치료방식중적시부위원발조수술、방료、경부림파결청소화수술정황적5년생존솔차이유통계학의의（ P＜0?05）。다인소분석현시，분화정도、국부복발、원발조수술、TNM분기화방료시영향TSCC예후적독립인소。결론원발조철저수술、합리경부림파결청소급예방국부복발능구개선TSCC환자적예후。조기TSCC건의수선수술치료，이중만기수선이수술위주적종합치료，술후방료적료효교호。
Objective To explore the prognostic factors for 132 cases with tongue squamous cell carcinoma( TSCC) in Xin-jiang. Methods One hundred and thirty-two patients with pathologically confirmed TSCC admitted by the first affiliated hospital of Xinjiang medical university from Jan 2003 to Dec 2011 were enrolled. There were 108 cases of surgery( 94 with routine cervical lymph node dissection) and 24 cases without surgery. According to the treatment protocols, 29 cases were treated with surgery alone, 10 cases with radiotherapy alone and 93 cases with comprehensive treatment. The patients were followed up and overall survival was estimated u-sing the Kaplan-Meier method. The 5-year survival rates of different clinicopathological parameters( gender, ethnicity, age, degree of differentiation, T stage, N stage, TNM stage, invading the tongue root, invading the midline, invading the mouth floor and local recur-rence) and treatment protocols( primary lesion resection, radiotherapy, chemotherapy, cervical lymph node dissection and surgical situ-ation) were investigated. The Cox regression was employed to analyze the independent prognostic factors. Results Of the 132 patients, 9 were lost during the follow-up periods ranging from 5 to 120 months with 61 alive and 62 dead( 58 of cancer-related diseases) . The median overall survival time was 80?0 months and 5-year survival rate was 59?8%. The 5-year survival rates varied among different de-gree of differentiation, T stage, N stage, TNM stage, invading the midline, invading the mouth floor and local recurrence or primary lesion resection, radiotherapy, cervical lymph node dissection and surgical situation. Degree of differentiation, lesion resection, local recurrence, TNM stage and radiotherapy were independent factors affecting the prognosis. Conclusion Curative resection of the prima-ry lesion, rational cervical lymph node dissection and prevention of local recurrence may improve the prognosis of patients with tongue squamous cell carcinoma. Surgery alone can provide better prognosis for stageⅠ-Ⅱ, and comprehensive therapy including surgery can give better prognosis for stage Ⅲ-Ⅳ.