| Objectives:The purpose of this study is to analyze the clinical and pathological features of locally advanced hypopharyngeal carcinoma,to explore the factors affecting the prognosis of patients with locally advanced hypopharyngeal carcinoma,to analyze the curative effect of different treatment methods,and to provide new ideas for the treatment of locally advanced hypopharyngeal carcinoma.Methods:This study is conducted in the study of locally advanced hypopharyngeal squamous cell carcinoma treated by otorhinolaryngology in Shanghai Changhai Hospital from January 2003 to December 2011.The research is divided into two parts.In the first part,the age,sex,history of tobacco and alcohol,course of disease,clinical manifestation,location of tumor,pathological grade,tumor stage,second primary cancer and other related clinical data are collected according to the statistics of previous cumulative data and the database of hospital cases,and the survival rate of the patients should follow up.According to Kaplan-Meier method,survival and single factor analysis are calculated and analyzed by Log-rank test,Cox regression model is used to analyze the multivariate factors,and the independent factors influencing the prognosis are obtained.In the second part,on the basis of the first part,the preoperative complications,primary and cervical lymph node treatment,postoperative defects repair and reconstruction,postoperative complications and other information are also collected according to the statistics of previous cumulative data and the database of hospital cases.All patients are grouped according to the different treatment methods,According to the Kaplan-Meier method,the survival rate is statistically analyzed.The Log-rank test is used to compare the efficacy of different treatments.Results:The first part,this study meets the inclusion criteria of patients with a total of 328 cases,including 312 cases of male(95.1%),16 cases are female(4.9%),the proportion of male and female 19.5:1,mean age 59.7±8.7,a total of 217 cases of patients with long-term history of alcohol and tobacco,accounted for 66.2%.According to the anatomic sub division,pyriform sinus carcinoma in 267 cases(81.4%),41 cases of retropharyngeal wall cancer(12.5%),20 cases of postcricoid cancer(6.1%).The degree of differentiation is 70 cases of moderately differentiated squamous cell carcinoma,moderately differentiated squamous cell carcinoma in 193 cases,and poorly differentiated squamous cell carcinoma in 65 cases.TNM stage : stage T2 61 cases(18.6%),T3 212 cases(64.6%),52 cases of stage T4a(15.9%),3 cases of stage T4b(0.9%);63 cases of stage NO(19.2%),N1 72 cases(22.0%),18 cases of stage N2a(5.5%),103 cases of stage N2b(31.4%),64 cases of stage N2c(19.5%),8 cases of stage N3(2.4%);M0 328 cases(100%).Clinical stage: stage III 119 cases(36.3%),stage IVA 198 cases(60.4%),stage IVB 11(3.3%).There were 29 patients(8.8%)with second primary cancer in all patients.Kaplan-Meier method is used to calculate the 3-year,5-year overall survival(OS)of 56.8% and 41.3%,respectively.In the univariate analysis,tumor stage is an important factor influencing the prognosis of patients.Multivariate analysis of Cox regression model shows that the independent prognostic facto is tumor stage(p <0.05).Second part,all the patients are divided into non-surgical group and operation group according to different treatment methods.In the non-surgical group,68(90.7%)are male and 7(9.3%)are female,with an average age of 61.8 ± 8.2 years.Of the 75 patients,18 are treated with radical radiotherapy alone,and 8 patients receive chemotherapy after radiotherapy,13 receive TPF regimen of induction chemotherapy before radiotherapy and 36 receive concurrent radiotherapy and chemotherapy.In the surgical group,244(96.4%)are male and 9(3.6%)are female,with an average age of 59.1 ± 8.7 years.All patients underwent complete resection of the tumor as the standard principle,and all patients underwent lymph node dissection,unilateral cervical lymph node dissection in 63 cases,bilateral cervical lymph node dissection in 190 cases,a total of 443 sides were cleaned.The throat and the surrounding mucosa,pectoralis major myocutaneous flap,forearm free flap,stomach and stomach pharyngeal anastomosis were used to repair and reconstruct the postoperative defects.According to the different programs,the surgical treatment group is divided into simple surgery group,preoperative chemoradiotherapy combined with surgery group and surgery combined with chemoradiotherapy group.The 3-year overall survival(OS)of the non-surgical treatment group and the surgical treatment group are 37.5% and 60.6% respectively by Kaplan-Meier method,the 5-year overall survival rate(OS)is 27.3%,45.2% respectively.After the Log-rank test,the difference between the two groups is statistically significant(p <0.05).The 3-year overall survival rates(OS)are40.3%,60.2%,66.2% in the patients treated with different treatment groups(simple surgery group,preoperative chemoradiotherapy combined with surgery group and surgery combined with chemoradiotherapy group),the 5-year survival rates are 20.1%,44.5%,46.7% respectively.After the Log-rank test,The difference between the three groups is statistically significant(p<0.05),and surgery combined with chemoradiotherapy group and preoperative chemoradiotherapy group are better than the surgery group.Conclusions:The prognosis of locally advanced hypopharyngeal carcinoma is poor.Before treatment should improve the relevant inspection and strict staging,which is conducive to the prognosis of the judge.Surgical patients,because they are at late stage,there are high risk factors,postoperative chemoradiotherapy should be taken to improve the efficacy of patients with surgery.Non-surgical patients,according to the patients' physical condition to take concurrent chemoradiotherapy or adjuvant chemotherapy. |
PDF Full Text Request