影响喉癌自然生存率的多因素分析
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摘要
目的:探讨喉癌的自然生存率及其影响因素。
方法:回顾性分析2000年1月1日至2007年12月31日188例未行喉切除术及放化疗治疗的喉癌患者的临床资料,包括年龄、吸烟史、肿瘤家族史、结核病史、肿瘤生长部位、病理学分级、T分期、N分期、临床分期以及有无气管切开术史。应用Kaplan-Meier乘极限法计算生存率,单因素分析组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型。
结果:总的中位生存时间为14±1.47月,1年、2年、5年生存率分别为54.7%、26.6%、11.0%;确诊超过5年的病例(除失访者外)尚无一例生存超过5年。0/Ⅰ/Ⅱ期中位生存时间为33±5.72月,1年、2年生存率分别为75.1%、57.9%;Ⅲ/Ⅳ期中位生存时间为10±1.31月,1年、2年生存率分别为43.2%、11.4%。单因素分析显示肿瘤生长部位、病理学分级、T分期、N分期、临床分期对生存率的影响有统计学意义(P<0.05),而是否行气管切开术无统计学意义。多因素分析显示病理学分级、临床分期对生存率的影响有统计学意义(P<0.05)。
结论:喉癌自然病程发展较快,在未针对肿瘤本身治疗的情况下,即便行姑息性手术如气管切开术亦不能提高生存率;影响喉癌自然生存率的因素为肿瘤生长部位、病理学分级、T分期、N分期、临床分期,其中独立危险因素为病理学分级和临床分期。
Objective To investigate the factors affecting the natural survival rates of laryngeal carcinoma.
Methods January 1,2000 to December 31,2007,one hundred and eighty eight laryngeal carcinoma cases without laryngectomy、radiotherapy and chemotherapy were analyzed restrospectively,including age,smoking,tumor family history,tuberculosis history,primary site, pathological grade,T-stage,N-stage,clinical stage and if had performed tracheotomy.Survival rates was calculated by Kaplan-Meier product-limit method.On univariate analysis,comparison among/between groups was performed using Log-rank test.Multivariate analysis was carried out using Cox proportional hazard model.
Results Overall median survival time was 14±1.47 months,overall 1-,2-,5-year survival rates were 54.7%,26.6%,11.0%,respectively.No patient survived over 5 years in these cases diagnosed more than 5 years (except for those who lost).The median survival time of 0/Ⅰ/Ⅱclinical stages was 33±5.72 months, 1-,2-year survival rates were 75.1%、 57.9%,respectively;the median survival time ofⅢ/Ⅳclinical stages was 10±1.31 months,1-,2-year survival rates were 43.2%、11.4%,respectively. Univariate analysis showed that primary site,pathological grade, T-stage, N-stage and clinical stage were proven to significant(P<0.05).If had performed tracheotomy that was nonsignificant to affect survival rates. Multivariate analysis showed survival rates statistically correlated with pathological grade and clinical stage(P<0.05).
Conclusion The development of laryngeal carcinoma natural course was faster, without treatment to the tumor itself, even if palliative surgical such as tracheostomy would not improve the survival rate;The factors affecting the natural survival rates of the patients with laryngeal carcinoma are primary site,pathological grade, T-stage, N-stage and clinical stage,the independent affecting factors are pathological grade and clinical stage.
方法:回顾性分析2000年1月1日至2007年12月31日188例未行喉切除术及放化疗治疗的喉癌患者的临床资料,包括年龄、吸烟史、肿瘤家族史、结核病史、肿瘤生长部位、病理学分级、T分期、N分期、临床分期以及有无气管切开术史。应用Kaplan-Meier乘极限法计算生存率,单因素分析组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型。
结果:总的中位生存时间为14±1.47月,1年、2年、5年生存率分别为54.7%、26.6%、11.0%;确诊超过5年的病例(除失访者外)尚无一例生存超过5年。0/Ⅰ/Ⅱ期中位生存时间为33±5.72月,1年、2年生存率分别为75.1%、57.9%;Ⅲ/Ⅳ期中位生存时间为10±1.31月,1年、2年生存率分别为43.2%、11.4%。单因素分析显示肿瘤生长部位、病理学分级、T分期、N分期、临床分期对生存率的影响有统计学意义(P<0.05),而是否行气管切开术无统计学意义。多因素分析显示病理学分级、临床分期对生存率的影响有统计学意义(P<0.05)。
结论:喉癌自然病程发展较快,在未针对肿瘤本身治疗的情况下,即便行姑息性手术如气管切开术亦不能提高生存率;影响喉癌自然生存率的因素为肿瘤生长部位、病理学分级、T分期、N分期、临床分期,其中独立危险因素为病理学分级和临床分期。
Objective To investigate the factors affecting the natural survival rates of laryngeal carcinoma.
Methods January 1,2000 to December 31,2007,one hundred and eighty eight laryngeal carcinoma cases without laryngectomy、radiotherapy and chemotherapy were analyzed restrospectively,including age,smoking,tumor family history,tuberculosis history,primary site, pathological grade,T-stage,N-stage,clinical stage and if had performed tracheotomy.Survival rates was calculated by Kaplan-Meier product-limit method.On univariate analysis,comparison among/between groups was performed using Log-rank test.Multivariate analysis was carried out using Cox proportional hazard model.
Results Overall median survival time was 14±1.47 months,overall 1-,2-,5-year survival rates were 54.7%,26.6%,11.0%,respectively.No patient survived over 5 years in these cases diagnosed more than 5 years (except for those who lost).The median survival time of 0/Ⅰ/Ⅱclinical stages was 33±5.72 months, 1-,2-year survival rates were 75.1%、 57.9%,respectively;the median survival time ofⅢ/Ⅳclinical stages was 10±1.31 months,1-,2-year survival rates were 43.2%、11.4%,respectively. Univariate analysis showed that primary site,pathological grade, T-stage, N-stage and clinical stage were proven to significant(P<0.05).If had performed tracheotomy that was nonsignificant to affect survival rates. Multivariate analysis showed survival rates statistically correlated with pathological grade and clinical stage(P<0.05).
Conclusion The development of laryngeal carcinoma natural course was faster, without treatment to the tumor itself, even if palliative surgical such as tracheostomy would not improve the survival rate;The factors affecting the natural survival rates of the patients with laryngeal carcinoma are primary site,pathological grade, T-stage, N-stage and clinical stage,the independent affecting factors are pathological grade and clinical stage.
引文
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[2] Nguyen-Tan PF,Le QT,Quivey JM,et al.Treatment results and prognostic factors of advanced T3-4 laryngeal carcinoma: the University of California, San Francisco (UCSF) and Stanford University Hospital (SUH) experience[J].Int J Radiat Oncol Biol Phys,2001,50(5):1172-1180.
[3]季文樾,杜强,关超,等.1115例喉癌患者的生存分析[J].中华耳鼻咽喉科杂志,2004,39(1):17-19.
[4]曾宗渊,陈福进,张诠,等.手术加放射治疗与单纯喉部分切除术治疗喉癌的疗效比较[J].中华耳鼻咽喉科杂志,2000,35(1):32-34.
[5] Jing J,Zhong Xing L,Li G,et al.Analysis of prognostic factors for T1N0M0 glottic cancer treated with definitive radiotherapy alone:experience of the cancer hospital of Peking Medical Collge and the Chinese Academy of Medical Sciences[J].Int J Radidation Oncol Biol Phy,2002,54(2):471-478.
[6] Haugen H, Johansson KA, Mercke C.Hyperfractionated-accelerated or conventionally fractionated radiotherapy for early glottic cancer[J].Int J Radiat Oncol Biol Phys,2002,52(1):109-119.
[7]葛俊恒,赵瑞利,胡俊兰.晚期喉癌的综合治疗分析[J].中华耳鼻咽喉科杂志,2004,39(1):20-23.
[8]宋金兰,黄永旺,双羽.喉癌喉切除术后复发部分相关因素的Meta分析[J].天津医科大学学报,2008,14(4):478-450.
[9] Spector JG,Sessions DG,Haughey BH,et al.Delayed regional metastases,distant metastases,and second primary malignancies in squamous cell carcinomas of the larynx and hypopharynx[J].Laryngoscope,2001,111(6):1079-1087.
[10]刘巍巍,曾宗渊,郭朱明,等.喉癌的远处转移和相关因素分析[J].中华耳鼻咽喉科杂志,2003,38(3):221-224.
[11]孙正良,冯秀荣,江文,等.108例喉癌手术疗效分析[J].中国耳鼻咽喉颅底外科杂志,2007,13(4):272-274.
[12] Reizenstein JA, Bergstr?m SN, Holmberg L,et al.Impact of age at diagnosis onprognosis and treatment in laryngeal cancer[J].Head Neck,2009,1: [Epub ahead of print].
[13] Shvero J,Hader T,Feinmesser R,et al.Laryngeal carcinoma in females[J].Eur J Surg Oncol,1996 ,22(1) : 61 - 64.
[14] Mayne ST,Cartmel B,Kirsh V,et al.Alcohol and tobacco use prediagnosis and postdiagnosis,and survival in a cohort of patients with early stage cancers of the oral cavity,pharynx,and larynx[J].Cancer Epidemiol Biomarkers Prev, 2009,18 (12):3368-3374.
[15]龙顺波,单希征,张安亮.喉癌与肺结核[J].山东大学基础医学院学报,2004,18(1):30-31.
[16]佟凯,屠规益.声门上型喉癌颈部淋巴结转移N1的处理与转移[J].中华耳鼻咽喉杂志,1996,31(50):307
[17] Redaelli de Zinis LO,Nicolai P,Tomenzoli D,et al.The distribution of lymph node metastases in supraglottic squamous cell carcinoma: therapeutic implications[J]. Head Neck,2002,24(10):913-920.
[18]李巍,季文樾,刘嵘.声门型喉癌颈淋巴结转移相关因素的研究[J].中华耳鼻咽喉科杂志,2003,38(4):304-306.
[19]张诠,赖非云,郭朱明等. 333例声门型喉癌颈淋巴结转移与预后的关系[J].癌症,2007,26(10):.1138-1142.
[20] Yang C Y,Andersen P E,Everts E C,et a1.Nodal disease in purely glottic carcinoma:is elective neck treatment worthwhile? [J].Laryngoscope,1998,108 (7):1006-1008.
[21] Chijiwa H,Sato K,Umeno H,et al.Histopathological study of correlation between laryngeal space invasion and lymph node metastasis in glottic carcinoma[J].J Laryngol Otol Suppl,2009,(31):48-51.
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