| Objective: Through a retrospective study of single central case data,the factors influencing the survival of postoperative and non-operative local advanced head and neck cancer after chemoradiotherapy were discussed.Methods: Were collected from January 2010 to December 2017 in Shengjing hospital affiliated to China medical university cancer center diagnosed by pathology of head and neck cancer,the cases who received adjuvant radiation and chemotherapy after surgery(R0,R1 resection)or non-operative patients underwent radical chemoradiotherapy,with a complete treatment and follow-up data.Main exclude ECOG PS > 2,pathology type cannot clear,with preoperative adjuvant radiation and chemotherapy patients,with distant metastasis and merging other primary tumors.For adjuvant purpose radiotherapy dose < 45 gy,radical purpose of radiation dose < 50 gy.All patients were divided into two groups: postoperative treatment group(S)and chemoradiotherapy group(R).Main collection of data including the patient's age,sex,smoking history,tumor site,pathological diagnosis,clinical pathologic stage,treatment and clinical pathology characteristics,and recording the recent efficacy of treatment and follow-up for DFS,PFS and OS and recently the survival data,treatment efficacy and survival analysis and related factors of prognosis.The statistical analysis was related to the survival of the prognosis,and kaplan-meier mapping and Log rank examination were used for survival comparison,and Cox model was adopted for multifactor analysis.Results: A total of 170 patients were enrolled in the group,The median age in the group was 58(21-87 years),with 124 males(72.9%).There were 121 cases of squamous cell carcinoma(71.2 %)and 49 cases of non-squamous cell carcinoma(28.8%).All patients were divided into two groups: postoperative adjuvant radiation therapy group(S)with 113 cases(66.5%)in group and Radical radiotherapy group(R)with 57 cases(33.5%)in group.The median follow-up time in S group and R group was 24.8 months and 15.8 months respectively.The DFS rate and OS rate of group Sfor 1-year and 2-year were 91.1%,82.8% and 92.8%,84.4% respectively.The OS rate of group R for 1-year were 67.8%.The multivariate analysis of S group showed that the patients' weight loss 10%,the degree of pathological differentiation,and the treatment were the independent risk factor for progression free survival(DFS)(HR=2.479,0.496,2.225,P <0.05);Weight change,pathological type,N staging,and treatment were the independent prognostic factors of Overall survival(OS)(HR=2.170,5.064,1.680,4.672,P <0.05);The multivariate analysis of R group showed that patients' gender,N stage were the independent risk factors of progression free survival(PFS)(HR = 6.832,3.281,P < 0.05);Clinical stage,treatment were the independent prognostic of Overall survival(OS)(HR = 2.016,2.912,P < 0.05).Conclusion: The weight loss,pathological type,N stage and treatment were the independent risk factors for the OS for the postoperative patients with head and neck cancer who received radiotherapy or chemoradiotherapy.The weight loss,squamous cell carcinoma,high N stage and simple radiotherapy indicated poor postoperative survival.The gender and N stage were the independent risk factors affecting PFS for patients with non-surgical local advanced head and neck cancer who receipt radiotherapy or chemoradiotherapy.Clinical stage and treatment are independent risk factors for OS.The risk of early recurrence was indicated by male and high N stage,and the prognosis was poor compared with radiotherapy alone. |
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