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摘要: 目的 探讨pT3N0期喉鳞癌的临床治疗策略。方法 对2011年7月至2022年6月于重庆医科大学附属第一医院行手术治疗的150例pT3N0期喉鳞癌患者进行回顾性分析，比较部分喉切除术与全喉切除术，单纯手术与手术+术后放疗分别对声门型及声门上型患者生存率的影响。结果 108例声门型患者中，部分喉切除术组和全喉切除术组的总生存(overall survival，OS)、疾病特异性生存(disease specific survival，DSS)、无疾病生存(disease free survival，DFS)差异无统计学意义(Log-rank=0.184、0.010、0.051，均P>0.05)；单纯手术组和手术+术后放疗组的OS、DSS、DFS差异无统计学意义(Log-rank=0.214、0.251、0.003，均P>0.05)。38例声门上型患者中，全喉切除术组的OS显著高于部分喉切除术组(Log-rank=7.338，P=0.007)；全喉切除术组的DSS和DFS有高于部分喉切除术组的趋势，但差异无统计学意义(Log-rank=0.895、1.792，均P>0.05)；手术+术后放疗组的DFS显著高于单纯手术组(Log-rank=7.172，P=0.007)，但2组的OS、DSS差异无统计学意义(Log-rank=0.010、0.876，均P>0.05)。结论 对于声门型pT3N0期喉癌患者，部分喉切除术与全喉切除术疗效相当，单纯手术与手术+术后放疗的疗效相当。对于声门上型pT3N0期喉癌患者，全喉切除术可提高生存率，术后放疗可降低复发，但仍需大样本的前瞻性随机对照研究进一步分析证实。Abstract: Objective To investigate optimal treatment strategy for pT3N0 laryngeal squamous cell carcinoma(SCC).Methods A retrospective study of 150 patients with pT3N0 laryngeal SCC treated in the First Affiliated Hospital of Chongqing Medical University was performed. The efficacies of partial laryngectomy and total laryngectomy, as well as surgery alone and postoperative radiotherapy were evaluated. The overall survival(OS), disease specific survival(DSS) and disease-free survival(DFS) were analyzed with statistical package from SPSS.Results Among the 108 patients with glottic laryngeal SCC, there were no significant differences in OS, DSS and DFS between the partial laryngectomy group and the total laryngectomy group(Log-rank=0.184, 0.010 and 0.051, P>0.05). Similarly, there were no significant differences in OS, DSS and DFS between the surgery-alone group and postoperative radiotherapy group(Log-rank=0.214, 0.251 and 0.003, P>0.05). Among the 38 patients with supraglottic laryngeal SCC, the OS in the total laryngectomy group was significantly higher than that in the partial laryngectomy group(Log-rank=7.338, P=0.007). The DSS and DFS in the total laryngectomy group were higher than in the partial laryngectomy group, but the differences were not statistically significant(Log-rank=0.895 and 1.792; P>0.05). The DFS in the postoperative radiotherapy group was significantly higher than in the surgery-alone group(Log-rank=7.172, P=0.007), but there were no significant differences in OS and DSS between these two groups(Log-rank=0.010 and 0.876, P>0.05).Conclusion For pT3N0 glottic laryngeal cancer patients, the efficacy of partial laryngectomy is comparable to total laryngectomy, same as surgery alone and postoperative radiotherapy. For pT3N0 supraglottic laryngeal cancer patients, total laryngectomy could improve the overall survival, and postoperative radiotherapy could reduce the recurrence. Prospectively randomized study with large samples is still needed.
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Key words:
- laryngeal neoplasms /
- surgical procedures /
- radiotherapy /
- prognosis
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表 1 150例pT3N0期喉鳞癌的临床病理特征和治疗情况
例(%) 项目 声门上型 声门型 声门下型 例数 38(25.3) 108(72.0) 4(2.7) 性别 男 35(92.1) 106(98.1) 4(100.0) 女 3(7.9) 2(1.9) 0 年龄(中位数)/岁 66(47~89) 63(20~88) 63(52~65) 病理分化 高分化 8(21.1) 37(34.3) 2(50.0) 中分化 22(57.9) 61(56.5) 2(50.0) 低分化 6(15.8) 5(4.6) 0 手术方式 全喉切除术 22(57.9) 43(39.8) 4(100.0) 部分喉切除术 16(42.1) 65(60.2) 0 颈淋巴结清扫 单侧 8(21.1) 64(59.3) 2(50.0) 双侧 30(78.9) 44(40.7) 2(50.0) 淋巴结清扫区域 Ⅱ、Ⅲ 6(15.8) 24(22.2) 0 Ⅱ、Ⅲ、Ⅳ 31(81.6) 82(76.0) 4(100) Ⅱ、Ⅲ、Ⅳ、Ⅴ 1(2.6) 1(0.9) 0 Ⅱ、Ⅲ、Ⅳ、Ⅵ 0 1(0.9) 0 术后是否放疗 否 13(34.2) 57(52.8) 1(25.0) 是 25(65.8) 51(47.2) 3(75.0) 治疗方式 单纯全喉 8(21.1) 26(24.1) 1(25.0) 全喉+术后放疗 14(36.8) 17(15.7) 3(75.0) 单纯部分喉 5(13.2) 31(28.7) 0 部分喉+术后放疗 11(28.9) 34(31.5) 0 
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