CAJ | 학술논문

目的分析局部晚期头颈部鳞癌患者经规范化的多学科综合治疗后的疗效及预后相关因素.方法收集2005年5月至201 1年12月间复旦大学附属肿瘤医院收治的局部晚期术后头颈部鳞癌患者125例,放疗技术均采用调强放疗(占93,6％)或三维适形放疗,分析患者的疗效和预后影响因素.结果全组患者的3年总生存率、3年无病生存率、3年局部区域控制率和3年无远处转移率分别为69.7％、56.1％、80.8％和73.1％.全组共有37例患者死亡,43例患者出现治疗失败,其中局部区域复发13例,远处转移20例,复发合并转移10例.远处转移是患者死亡的首位原因,肺和纵隔淋巴结为最常见的转移部位.单因素分析显示,手术方式、是否仅行颈部淋巴结清扫术、受侵淋巴结最大直径、N分期和有无脉管癌栓与局部晚期头颈部鳞癌患者的3年总生存率有关(均P＜0.05,);手术方式、是否仅行颈部淋巴结清扫术和受侵淋巴结最大直径与患者的3年局部区域控制率有关(均P ＜0.05,);是否仅行颈部淋巴结清扫术、N分期、TNM分期以及有无脉管癌栓与患者的3年无远处转移率有关(均P ＜0.05).Cox回归模型分析的结果显示,手术方式是影响局部晚期头颈部鳞癌患者总生存的独立因素(P=0.001);受侵淋巴结的最大直径是影响患者局部区域复发的独立因素(P=0.001);N分期、T分期和有无脉管癌栓是影响患者远处转移的独立因素(均P≤0.05).结论局部晚期头颈部鳞癌患者经过手术和术后辅助治疗的综合治疗后取得了较好的疗效.局部控制手段的进步使得远处转移成为目前主要的治疗失败模式及首位死亡原因.
목적 분석국부만기두경부린암환자경규범화적다학과종합치료후적료효급예후상관인소.방법 수집2005년5월지201 1년12월간복단대학부속종류의원수치적국부만기술후두경부린암환자125례,방료기술균채용조강방료(점93,6％)혹삼유괄형방료,분석환자적료효화예후영향인소.결과 전조환자적3년총생존솔、3년무병생존솔、3년국부구역공제솔화3년무원처전이솔분별위69.7％、56.1％、80.8％화73.1％.전조공유37례환자사망,43례환자출현치료실패,기중국부구역복발13례,원처전이20례,복발합병전이10례.원처전이시환자사망적수위원인,폐화종격림파결위최상견적전이부위.단인소분석현시,수술방식、시부부행경부림파결청소술、수침림파결최대직경、N분기화유무맥관암전여국부만기두경부린암환자적3년총생존솔유관(균P＜0.05,);수술방식、시부부행경부림파결청소술화수침림파결최대직경여환자적3년국부구역공제솔유관(균P ＜0.05,);시부부행경부림파결청소술、N분기、TNM분기이급유무맥관암전여환자적3년무원처전이솔유관(균P ＜0.05).Cox회귀모형분석적결과현시,수술방식시영향국부만기두경부린암환자총생존적독립인소(P=0.001);수침림파결적최대직경시영향환자국부구역복발적독립인소(P=0.001);N분기、T분기화유무맥관암전시영향환자원처전이적독립인소(균P≤0.05).결론 국부만기두경부린암환자경과수술화술후보조치료적종합치료후취득료교호적료효.국부공제수단적진보사득원처전이성위목전주요적치료실패모식급수위사망원인.
Objective To investigate the treatment outcome of loco-regionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) after been treated with multi-modality approach since 2005 in our hospital and to explore the prognostic factors for treatment outcomes.Methods Clinical data of 125 postoperative LA-SCCHN patients treated in our department with radiotherapy/chemoradiotherapy from May 2005 to December 2011 were collected and reviewed in this study.The radiotherapy technique was intensity-modulated radiotherapy (IMRT) (93.6％) and a minority of patients received 3D-conformal radiotherapy (3D-CRT).Results Up to January 6th,2013,124 patients were followed up with a median follow-up duration of 25 months.The 3-year overall survival (OS),disease-free survival (DFS),locoregional control (LRC),distant metastasis-free survival (DMFS) were 69.7％,56.1％,80.8％,and 73.1％,respectively.A total of 37 patients died during the follow-up period.Among the 43 patients presented with treatment failure,13 patients had loco-regional relapse,20 patients had distant metastasis and 10 patients presented with both loco-regional and distant relapses.Distant metastasis accounted for the predominant cause of death.Lung and mediastinal lymph nodes are the most common sites involved by distant metastasis.Univariate analysis indicated that patients who underwent non-radical surgery,with larger size of invaded lymph nodes,higher N stage (N2b and above) and vascular tumor embolism had a lower OS (P =0.001,0.000,0.032,0.007,respectively).Patients who underwent neck dissection only,or those with higher N stage (N2b and above) or higher TNM stage or vascular tumor thrombi had higher distant metastasis rates (P =0.017,0.002,0.008,0.001,respectively).The multivariate analysis showed that non-radical surgery was an independent prognostic factor for OS (P =0.001),larger size of invaded lymph nodes was an independent prognostic factor for poorer LRC (P =0.001) ; higher N stage (N2b and above) or T4 stage and vascular tumor thrombi were indepcndent prognostic factors for poorer distant metastasis-free survival (P =0.035,0.008 and 0.050,respectively).Conclusions Our results indicate that multimodality treatment for LA-SCCHN has achieved better outcome than before.Distant metastasis has become the predominant pattern of failure as well as the primary cause of death instead of loco-regional relapse as a result of improved local control modality.More efforts should be made to decrease the rate of distant metastasis in the future.