中国生化药物杂志
中國生化藥物雜誌
중국생화약물잡지
CHINESE JOURNAL OF BIOCHEMICAL PHARMACEUTICS
2014年
3期
93-97
,共5页
早期声门型喉癌%手术治疗%放疗%光动力治疗%化疗%预后因素
早期聲門型喉癌%手術治療%放療%光動力治療%化療%預後因素
조기성문형후암%수술치료%방료%광동력치료%화료%예후인소
early glottic carcinoma%surgery%rediotherapy%photodynamic therapy%chemotherapy%prognostic factors
目的：探讨手术、放疗和光动力治疗联合小剂量化疗治疗早期声门型喉癌的疗效和影响预后的因素。方法回顾性分析122例Tis～T2 N0 M0期声门型喉癌患者的临床资料。122例患者中，小剂量化疗采用单药顺铂（按体表面积50 mg/m2）；共分为3组：行手术治疗联合小剂量化疗（手术组，n＝83），行放疗联合小剂量化疗（放疗组，n＝20）接受光动力治疗联合小剂量化疗（光动力组，n＝19）。结果手术组、放疗组和光动力组的3年和5年总生存率（overall survival，OS）分别为92.7％、93.8％和89.5％、89.5％和84.4％、89.5％。手术组、放疗组和光动力组的2年无瘤生存率（disease-freesurvival，DFS）分别为87.6％、79.4％和78.6％。手术组、放疗组和光动力组治疗后的2年局部控制率（local control，LC）分别为91.9％、84.4％和83.0％。3组中27例出现局部区域复发或颈部淋巴结转移，手术组中15例复发，放疗组中3例复发，光动力组5例复发，19例进行了挽救性手术。Cox多因素回归分析显示：前联合受侵、临床分期、治疗前卡氏评分是影响总生存率的独立因素。无瘤生存率的不良预后因素是前联合受侵（P＝0.027）和分化程度（P＝0.041），前联合受侵也是局部控制率（P＝0.047）的不良预后因素。结论通过对早期声门型喉癌患者的回顾性分析，手术组、放疗组与光动力组3种治疗方法疗效相近，均达到了较好效果。光动力治疗和放射治疗可以作为早期声门型喉癌的主要治疗手段，光动力治疗和放疗联合小剂量化疗很大程度保存正常喉结构和功能，大幅度提高患者生活质量。治疗前KPS评分、声带活动受限及分化程度是影响OS的主要因素。
目的：探討手術、放療和光動力治療聯閤小劑量化療治療早期聲門型喉癌的療效和影響預後的因素。方法迴顧性分析122例Tis～T2 N0 M0期聲門型喉癌患者的臨床資料。122例患者中，小劑量化療採用單藥順鉑（按體錶麵積50 mg/m2）；共分為3組：行手術治療聯閤小劑量化療（手術組，n＝83），行放療聯閤小劑量化療（放療組，n＝20）接受光動力治療聯閤小劑量化療（光動力組，n＝19）。結果手術組、放療組和光動力組的3年和5年總生存率（overall survival，OS）分彆為92.7％、93.8％和89.5％、89.5％和84.4％、89.5％。手術組、放療組和光動力組的2年無瘤生存率（disease-freesurvival，DFS）分彆為87.6％、79.4％和78.6％。手術組、放療組和光動力組治療後的2年跼部控製率（local control，LC）分彆為91.9％、84.4％和83.0％。3組中27例齣現跼部區域複髮或頸部淋巴結轉移，手術組中15例複髮，放療組中3例複髮，光動力組5例複髮，19例進行瞭輓救性手術。Cox多因素迴歸分析顯示：前聯閤受侵、臨床分期、治療前卡氏評分是影響總生存率的獨立因素。無瘤生存率的不良預後因素是前聯閤受侵（P＝0.027）和分化程度（P＝0.041），前聯閤受侵也是跼部控製率（P＝0.047）的不良預後因素。結論通過對早期聲門型喉癌患者的迴顧性分析，手術組、放療組與光動力組3種治療方法療效相近，均達到瞭較好效果。光動力治療和放射治療可以作為早期聲門型喉癌的主要治療手段，光動力治療和放療聯閤小劑量化療很大程度保存正常喉結構和功能，大幅度提高患者生活質量。治療前KPS評分、聲帶活動受限及分化程度是影響OS的主要因素。
목적：탐토수술、방료화광동력치료연합소제양화료치료조기성문형후암적료효화영향예후적인소。방법회고성분석122례Tis～T2 N0 M0기성문형후암환자적림상자료。122례환자중，소제양화료채용단약순박（안체표면적50 mg/m2）；공분위3조：행수술치료연합소제양화료（수술조，n＝83），행방료연합소제양화료（방료조，n＝20）접수광동력치료연합소제양화료（광동력조，n＝19）。결과수술조、방료조화광동력조적3년화5년총생존솔（overall survival，OS）분별위92.7％、93.8％화89.5％、89.5％화84.4％、89.5％。수술조、방료조화광동력조적2년무류생존솔（disease-freesurvival，DFS）분별위87.6％、79.4％화78.6％。수술조、방료조화광동력조치료후적2년국부공제솔（local control，LC）분별위91.9％、84.4％화83.0％。3조중27례출현국부구역복발혹경부림파결전이，수술조중15례복발，방료조중3례복발，광동력조5례복발，19례진행료만구성수술。Cox다인소회귀분석현시：전연합수침、림상분기、치료전잡씨평분시영향총생존솔적독립인소。무류생존솔적불량예후인소시전연합수침（P＝0.027）화분화정도（P＝0.041），전연합수침야시국부공제솔（P＝0.047）적불량예후인소。결론통과대조기성문형후암환자적회고성분석，수술조、방료조여광동력조3충치료방법료효상근，균체도료교호효과。광동력치료화방사치료가이작위조기성문형후암적주요치료수단，광동력치료화방료연합소제양화료흔대정도보존정상후결구화공능，대폭도제고환자생활질량。치료전KPS평분、성대활동수한급분화정도시영향OS적주요인소。
Objective To investigate the curative effect of surgery,radiotherapy and photodynamic therapy combined with chemotherapy on early glottic carcinoma and prognostic factors.Methods Clinical data of 122 cases of early glottic carcinoma with Tis ~T2 N0 M0 were analyzed retrospectively.Small doses of chemotherapy applied to single drug cisplatin (according to the surface area of 50 mg/m2 ).83 patients underwent surgical treatments combined with chemotherapy,20 cases accepted radiotherapy combined with chemotherapy and 19 cases accepted photodynamic therapy combined with chemotherapy. Results The 3 and 5 years overall survival rates (overall survival,OS ) of surgery group,radiotherapy group and photodynamic group were 92.7%,93.8% and 89.5%,89.5% and 84.4% ,89.5%,respectively.The 2-year disease free survival rate (disease-freesurvival,DFS)were 87.6%,79.4%,78.6%,respectively.The 2-year local control rate(local control,LC)were 91.9%,84.4%,83.0%, respectively.27 cases suffered from tumor recurrence or metastasis,15 cases in the surgery group,3 cases in the radiotherapy group and 5 cases in the photodynamic group,among them 19 patients accepted salvage surgery.Multifactor retrospective analysis indicated anterior commissure invasion (P=0.047),clinical stage(P =0.018)and KPS score before treatment(P =0.001)were independent adverse prognostic factors for OS.Anterior commissure invasion(P=0.027)and differentiation degree(P=0.041)were adverse prognostic factors for DFS.Anterior commissure invasion was also poor prognostic features for LC(P=0.047).Conclusion Radiotherapy and photodynamic therapy combined with chemotherapy may be the first or very important treatment on early stage glottic squamous cell cancer(Tis ~T2N0M0 ).High preservation rate of laryngeal function with radiotherapy and photodynamic therapy combined with chemotherapy can significantly improved quality of life of patients.Curative effect of three groups was similar,and three kinds of curative methods achieved good effect.KPS score before treatment,glottis impair and differentiation degree were the main adverse prognostic factors for early stage glottic carcinoma.
