摘要
目的:探讨喉癌术后放疗患者复发的影响因素、各术式下不同放疗剂量与复发的关系及对生存率的影响。方法:回顾性分析石家庄市人民医院收治的134例喉癌术后放疗患者临床资料,先对其进行单因素分析,后采用多因素Logistic回归分析术后复发的危险因素。同时探讨不同放疗剂量与各术式的关系,利用Kaplan-meler法、Log rank检验对喉癌患者2年生存率进行分析。结果:134例患者中,30例术后复发者设为复发组,其余104例为未复发组。经多因素Logistic回归分析可知,临床分期(Ⅲ~Ⅳ期)、T分期(T3~T4期)、N分期(N1~N3)、放疗剂量(低剂量)、甲状腺软骨受侵(是)、手术切缘(阳性)为喉癌术后复发的独立危险因素(OR>1,P<0.05)。支撑喉镜下激光声带肿物切除/喉部分切除术、喉全切除术后接受高剂量放疗患者复发率分别低于接受低剂量放疗患者,总复发率相比具有统计学差异(P<0.05)。截至2023年6月,134例喉癌术后放疗患者中,中位随访时间为14.23个月(1~24个月),其中低剂量组死亡8例,高剂量组死亡2例,中位生存时间估计值分别为19.13、22.13月,患者的生存曲线具有差异性(Log rank P=0.20),高剂量组优于低剂量组。结论:喉癌术后联合放疗的整体疗效较好,但临床分期、T分期、N分期、低剂量放疗、肿瘤侵及甲状腺软骨、手术切缘阳性、术后至放疗结束时间>11周因素均可影响疾病复发,临床上应当结合患者病情适当调高放疗剂量,以改善预后,延长生存期限。
Objective To explore the factors associated with laryngeal cancer relapse after postoperative radiotherapy,discuss the relationship between radiotherapy dose under various surgical procedures and relapse,and analyze their effects on survival rate.Methods The clinical data of 134 patients with laryngeal cancer treated with postoperative radiotherapy in Shijiazhuang People's Hospital were retrospectively analyzed.The risk factors of postoperative relapse were analyzed with univariate analysis,followed by multivariate Logistic regression analysis.The relationships between radiotherapy doses under various surgical procedures and the relapse were discussed.Kaplan-meler method and Log rank test were used to analyze the 2-year survival rate of laryngeal cancer patients.Results Thirty out of the 134 patients relapsed after treatment,and there was no recurrence in the remaining 104 patients.Multivariate Logistic regression analysis identified clinical stage( Ⅲ-Ⅳ),T stage(T3-T4),N stage(N1-N3),radiotherapy dose(low-dose),thyroid cartilage invasion(yes) and surgical margin(positive) as independent risk factors for postoperative laryngeal cancer relapse(OR>1,P<0.05).The relapse rates of patients receiving high-dose radiotherapy after laser vocal cord mass resection/partial laryngectomy and total laryngectomy under self-retaining laryngoscope were lower than those of patients receiving low-dose radiotherapy,with a statistically significant difference in overall relapse rate(P<0.05).As of June 2023,the median follow-up time of 134 patients undergoing postoperative radiotherapy for laryngeal cancer was 14.23 months(1-24 months),and there were 8 deaths in low-dose group and 2 deaths in high-dose group.The estimated median survival times in low-and high-dose groups were 19.13 months and22.13 months.The survival curves in two groups were different(Log rank P=0.20),with high-dose group outperforming lowdose group.Conclusion The overall therapeutic effect of surgery combined with postoperative radiotherapy for laryngeal cancer is favorable.However,clinical stage,T stage,N stage,low-dose radiotherapy,tumor invasion into thyroid cartilage,positive surgical margin,and >11 weeks from postoperation to radiotherapy completion were risk factors for disease relapse.In clinical practice,the radiotherapy dose should be appropriately increased based on the patient's condition to improve prognosis and extend survival duration.
作者
刘彬
胡智慧
孔娜
李炎
陈坤
LIU Bin;HU Zhihui;KONG Na;LI Yan;CHEN Kun(Department of Otolaryngology Head and Neck Surgery,Shijiazhuang People's Hospital,Shijiazhuang 050000,China;The First Department of Oncology,Shijiazhuang People's Hospital,Shijiazhuang 050000,China;Department of Orthopaedics,the Third Hospital of Shijiazhuang,Shijiazhuang 050011,China)
出处
《中国医学物理学杂志》
CSCD
2024年第2期158-162,共5页
Chinese Journal of Medical Physics
基金
石家庄市科技计划(221200603)
河北省卫生厅科研基金(20160002)。
关键词
喉癌
术后放射治疗
放射剂量
复发
生存曲线
影响因素
laryngeal cancer
postoperative radiotherapy
radiotherapy dose
relapse
survival curve
influencing factor
