CAJ | 학술논문

目的对比以手术为主和以放疗为主综合治疗方法在Ⅲ、Ⅳ期喉癌治疗中的疗效,探索Ⅲ、Ⅳ期喉癌合理的治疗方法.方法回顾性分析Ⅲ、Ⅳ期喉癌103例(Ⅲ期39例,Ⅳ期64例)的临床资料.根据治疗方法分为手术±放疗组(S±R组,46例)和放疗或放化疗±挽救手术组(R±S组,57例).分析对比两组的总生存(OS)率、无复发生存(RFS)率和喉保留率.多因素分析影响Ⅲ、Ⅳ期喉癌患者生存率和喉保留率的独立因素.结果 S±R组2年OS率、RFS率分别为74.7％(34/46)、72.4％(33/46),优于R±S组的46.4％(26/57)、40.9％(23/57)(P＜0.05).R±S组的喉保留率高于S±R组[32.6％(15/46)比93.0％(53/57),P＜ 0.05].影响预后的独立因素为治疗方法和T分期,影响喉保留率的独立因素为治疗方法.结论手术±放疗治疗Ⅲ、Ⅳ期喉癌的生存率优于放疗或放化疗±挽救手术,而前者喉保留率则低于后者.Ⅲ、Ⅳ期喉癌应以手术±放疗为首选治疗方法,生活质量的改善宜通过喉功能保留手术和发音重建的方法来实现.
목적 대비이수술위주화이방료위주종합치료방법재Ⅲ、Ⅳ기후암치료중적료효,탐색Ⅲ、Ⅳ기후암합리적치료방법.방법 회고성분석Ⅲ、Ⅳ기후암103례(Ⅲ기39례,Ⅳ기64례)적림상자료.근거치료방법분위수술±방료조(S±R조,46례)화방료혹방화료±만구수술조(R±S조,57례).분석대비량조적총생존(OS)솔、무복발생존(RFS)솔화후보류솔.다인소분석영향Ⅲ、Ⅳ기후암환자생존솔화후보류솔적독립인소.결과 S±R조2년OS솔、RFS솔분별위74.7％(34/46)、72.4％(33/46),우우R±S조적46.4％(26/57)、40.9％(23/57)(P＜0.05).R±S조적후보류솔고우S±R조[32.6％(15/46)비93.0％(53/57),P＜ 0.05].영향예후적독립인소위치료방법화T분기,영향후보류솔적독립인소위치료방법.결론 수술±방료치료Ⅲ、Ⅳ기후암적생존솔우우방료혹방화료±만구수술,이전자후보류솔칙저우후자.Ⅲ、Ⅳ기후암응이수술±방료위수선치료방법,생활질량적개선의통과후공능보류수술화발음중건적방법래실현.
Objective To compare the treatment outcome of underwent surgery plus radiotherapy and radiotherapy/chemoradiotherapy plus salvage surgery for stage Ⅲ/Ⅳ laryngeal carcinoma,to investigate an optimized treatment for the patients of stage Ⅲ/Ⅳ laryngeal carcinoma.Methods Clinical data from 103 patients with stage Ⅲ (39 cases) or stage Ⅳ (64 cases) laryngeal carcinoma were retrospectively analyzed.The patients were divided into surgery plus radiotherapy group (S±R,46 cases) and radiotherapy/chemoradiotherapy plus salvage surgery group (R±S,57 cases).Overall survival,relapse free survival,and laryngeal preservation rate were used to compare the treatment outcome between two groups.Multivariate regression models were used to analyze the independent factors for survival and laryngeal preservation rate.Results Survival rate was higher in S±R group than in R±S group [2 year overall survival/relapse free survival 74.7 ％ (34/46) / 72.4 ％ (33/46) vs 46.4 ％ (26/57) / 40.9 ％ (23/57),P ＜ 0.05].Laryngeal preservation rate was higher in R±S group than in S±R group [93.0 ％ (15/46) vs 32.6 ％ (53/57),P ＜ 0.05].Multivariate analysis demonstrated that treatment modality and T stage were independent factors for long-term survival,while treatment modality was the only an independent factor for laryngeal preservation rate.Conclusions Surgery plus radiotherapy result in better survival and lower laryngeal preservation rate than radiotherapy/chemoradiotherapy plus salvage surgery in treatment of stage Ⅲ/Ⅳ laryngeal carcinoma.Surgery plus radiotherapy should be the first choice for treatment of locally advanced laryngeal carcinoma.Improvement of the quality of life could be achieved by laryngeal preservation surgery and phonation reconstruction procedures.