中国肿瘤临床
中國腫瘤臨床
중국종류림상
CHINESE JOURNAL OF CLINICAL ONCOLOGY
2013年
7期
403-406
,共4页
陈龙%刘跃平%黄江琼%谢小妹%梁霞
陳龍%劉躍平%黃江瓊%謝小妹%樑霞
진룡%류약평%황강경%사소매%량하
上颌窦%鳞状细胞癌%放射治疗%病理组织学反应%预后
上頜竇%鱗狀細胞癌%放射治療%病理組織學反應%預後
상합두%린상세포암%방사치료%병리조직학반응%예후
maxillary sinus%squamous cell carcinoma%radiation therapy%tumor regression%prognosis
目的:分析上颌窦鳞状细胞癌术前放疗后显微镜下病理反应程度与局部控制率和长期生存率的关系.方法:1994年1月至2003年5月接受术前放疗的上颌窦鳞状细胞癌36例,男26例,女10例,中位年龄为57.5岁.临床分期:Ⅱ期2例,Ⅲ期12例,Ⅳ期22例,受侵上颌窦区中位放疗剂量为60Gy,中位休息23d后行上颌窦癌根治性切除术,术后标本连续切片并HE染色,显微镜下评价肿瘤组织放疗反应程度并分析其与肿瘤局部控制率和长期生存率的关系.结果:依据恶性肿瘤放(化)疗后病理反应分度标准,Ⅰ度放疗反应为33.3%,Ⅱ度为16.7%,Ⅲ度为50.0%.治疗后中位随诊51个月,随诊期间复发14例,占38.9%,其中局部复发13例.全组治疗后5年总生存率为70.9%,5年无病生存率为60.5%.肿瘤组织Ⅰ、Ⅱ、Ⅲ度放疗反应的总生存率和无病生存率有显著差异,但Ⅱ、Ⅲ度放疗反应组之间无显著性差异,将Ⅱ、Ⅲ度合并为重度反应组,Ⅰ度定为轻度反应组,两组的局部复发率分别为12.5%和83.3%(P<0.001).重度反应组与轻度反应组的5年无病生存率和总生存率分别为87.1%和91.3%与8.3%和30.0%,P值均<0.001.综合性别、年龄、病理分化、放疗剂量、放疗与手术间隔时间、临床分期以及肿瘤放疗反应程度的多因素回归分析提示肿瘤组织反应程度是重要的预后影响因素.结论:上颌窦鳞状细胞癌放疗后显微镜下肿瘤组织反应程度与预后密切相关,是重要的预后指标.
目的:分析上頜竇鱗狀細胞癌術前放療後顯微鏡下病理反應程度與跼部控製率和長期生存率的關繫.方法:1994年1月至2003年5月接受術前放療的上頜竇鱗狀細胞癌36例,男26例,女10例,中位年齡為57.5歲.臨床分期:Ⅱ期2例,Ⅲ期12例,Ⅳ期22例,受侵上頜竇區中位放療劑量為60Gy,中位休息23d後行上頜竇癌根治性切除術,術後標本連續切片併HE染色,顯微鏡下評價腫瘤組織放療反應程度併分析其與腫瘤跼部控製率和長期生存率的關繫.結果:依據噁性腫瘤放(化)療後病理反應分度標準,Ⅰ度放療反應為33.3%,Ⅱ度為16.7%,Ⅲ度為50.0%.治療後中位隨診51箇月,隨診期間複髮14例,佔38.9%,其中跼部複髮13例.全組治療後5年總生存率為70.9%,5年無病生存率為60.5%.腫瘤組織Ⅰ、Ⅱ、Ⅲ度放療反應的總生存率和無病生存率有顯著差異,但Ⅱ、Ⅲ度放療反應組之間無顯著性差異,將Ⅱ、Ⅲ度閤併為重度反應組,Ⅰ度定為輕度反應組,兩組的跼部複髮率分彆為12.5%和83.3%(P<0.001).重度反應組與輕度反應組的5年無病生存率和總生存率分彆為87.1%和91.3%與8.3%和30.0%,P值均<0.001.綜閤性彆、年齡、病理分化、放療劑量、放療與手術間隔時間、臨床分期以及腫瘤放療反應程度的多因素迴歸分析提示腫瘤組織反應程度是重要的預後影響因素.結論:上頜竇鱗狀細胞癌放療後顯微鏡下腫瘤組織反應程度與預後密切相關,是重要的預後指標.
목적:분석상합두린상세포암술전방료후현미경하병리반응정도여국부공제솔화장기생존솔적관계.방법:1994년1월지2003년5월접수술전방료적상합두린상세포암36례,남26례,녀10례,중위년령위57.5세.림상분기:Ⅱ기2례,Ⅲ기12례,Ⅳ기22례,수침상합두구중위방료제량위60Gy,중위휴식23d후행상합두암근치성절제술,술후표본련속절편병HE염색,현미경하평개종류조직방료반응정도병분석기여종류국부공제솔화장기생존솔적관계.결과:의거악성종류방(화)료후병리반응분도표준,Ⅰ도방료반응위33.3%,Ⅱ도위16.7%,Ⅲ도위50.0%.치료후중위수진51개월,수진기간복발14례,점38.9%,기중국부복발13례.전조치료후5년총생존솔위70.9%,5년무병생존솔위60.5%.종류조직Ⅰ、Ⅱ、Ⅲ도방료반응적총생존솔화무병생존솔유현저차이,단Ⅱ、Ⅲ도방료반응조지간무현저성차이,장Ⅱ、Ⅲ도합병위중도반응조,Ⅰ도정위경도반응조,량조적국부복발솔분별위12.5%화83.3%(P<0.001).중도반응조여경도반응조적5년무병생존솔화총생존솔분별위87.1%화91.3%여8.3%화30.0%,P치균<0.001.종합성별、년령、병리분화、방료제량、방료여수술간격시간、림상분기이급종류방료반응정도적다인소회귀분석제시종류조직반응정도시중요적예후영향인소.결론:상합두린상세포암방료후현미경하종류조직반응정도여예후밀절상관,시중요적예후지표.
@@@@Objective: Preoperative radiotherapy has an important role in the treatment of maxillary squamous cell carcinoma. The role of tumor regression grading after radiotherapy on survival has not been reported to date. This study evaluates pathologic tumor regression grading of maxillary squamous cell carcinoma after preoperative radiotherapy and its prognostic value in correlation to long-term survival. Methods: Between January 1994 to May 2003, 36 patients with maxillary squamous cell carcinoma who were treat-ed with preoperative radiotherapy were examined. Patients were composed of 26 males and 10 females with a median age of 57.5 years. Two patients had stage Ⅱ, 12 had stage Ⅲ, and 22 had stage Ⅳ diseases. Patients received 40 Gy to 90 Gy (median 60) preoperative ir-radiation to the maxillary area involved. Then, radical resection of the tumor was performed after a median break of 23 days. Serial sec-tions of whole surgical specimens were examined using hematoxylin and eosin stain. Tumor regression was graded according to the his-topathological grading criteria of chemotherapy- and radiotherapy-induced tumor regression. The relationship between treatment out-come (local control and overall survival) and pathologic tumor regression was analyzed. Results: According to the grading criteria of pathologic tumor regression, 33.3% of the patients had Grade I, 16.7% had Grade Ⅱ, and 50.0% had Grade Ⅲtumor regressions. With a median follow-up of 51 months, 14 patients (38.9%) recurred and 13 locally recurred. Five-year overall survival and five-year dis-ease-free survival were 70.9% and 60.5% , respectively. Overall survival and disease-free survival correlated with tumor regression grades, but the survival difference between Grade Ⅱ and Grade Ⅲ was not significant. When Grades Ⅱ and Ⅲ were combined as 'se-vere responders' and Grade I was designated as 'mild responders,' the overall and disease-free survivals of the severe responders were 91.3% and 87.1%, respectively, whereas those of the mild responders were 30.0% and 8.3%, respectively (P<0.001). Ten of the 12 (83.3%) patients with mild responders developed local recurrence, whereas three of the 24 (12.5%) patients with severe responders de-veloped local recurrence (P<0.001). Multivariate analysis confirmed that histopathological tumor regression after radiotherapy is an im-portant prognostic factor in maxillary squamous cell carcinoma (P=0.001). Conclusion: Microscopic histopathological evidence of tu-mor regression after radiotherapy in maxillary squamous cell carcinoma is an important prognostic factor in the long-term survival of patients.
