扁桃体鳞状细胞癌的治疗

摘要

Objective To evaluate the treatment outcome of different therapeutic modalities for squamous-cell carcinoma of tonsil and prognostic factors. Methods Forty cases pathologically confirmed with squamous-cell carcinoma of tonsil without distant metastasis treated from 1990 to 2011 were reviewed. Kaplan-Meier method and Log-rank test were used for survival analysis, multivariate analysis using the Cox regression model. Results The overall 5 year survival rate of 40 patients with squamous-cell carcinoma of tonsil was 41. 7%. The 5 year survival of the patients at stage I and II was 74.2% , while the rate was 26. 1 % in the patients at stage ID and 0% in the patients at stage IV (x2 =4.258, P < 0.05). The 5 year survival rate was 32.4% in radiotherapy alone group and 30.2% in comprehensive therapy group, respectively (X2 =0.409, P>0.05). The 5 years survival rate of N + patients was higher than that of No(x2 =9. 987, P<0.05). Cox analysis showed TNM stage, differentiation of tumor and cervical metastatic lymph node were the independent prognostic factors ( P < 0.05). Conclusions TNM stage, differentiation of tumor and cervical metastatic lymph node were the independent prognostic factors. For I - II staged squamous-cell carcinoma of tonsil cases were tendency to choice simple radiotherapy. For Ⅲ-IV staged cases, the relationships therapeutic mode and therapeutic effect still need further researches.%目的 分析扁桃体鳞状细胞癌不同治疗方案对患者生存率的影响,以期明确影响预后的因素并指导临床治疗.方法 回顾性分析1990～2011年南京医科大学附属淮安第一医院耳鼻咽喉头颈外科和头颈放疗科治疗的经病理证实、无远处转移的扁桃体鳞癌40例患者临床资料.采用Kaplan-Meier法和Log-rank检验进行生存分析,多因素分析采用Cox回归模型.结果 40例扁桃体鳞癌患者5年生存率为41.7％,Ⅰ～Ⅱ期5年生存率为74.2％,Ⅲ期为26.1％,Ⅳ期为0％,差异有统计学意义(x2=4.258,P＜0.05).单纯放疗组、综合治疗组(手术联合放化疗组和化疗联合放疗组)5年生存率分别为32.4％和30.2％,差异无统计学意义(x2=0.409,P＞0.05).有、无淋巴转移患者5年生存率分别为62.2％和8.4％,差异有统计学意义(x2 =9.987,P＜0.05).Cox多因素分析显示TNM分期、病理分化和颈淋巴结是否转移为影响预后的独立危险因素(P＜0.05).结论 Ⅰ～Ⅱ期扁桃体鳞癌的治疗倾向于单纯放疗,Ⅲ～Ⅳ期扁桃体鳞癌的治疗模式和疗效仍需进一步研究.TNM分期、病理分化和淋巴结是否转移为影响预后的独立危险因素.