PLoS One：吴一龙等确认喉鳞状细胞癌预后的影响因素

    在2013年4月4日出版的PLoS One杂志上，发表了我国广东省人民医院 吴一龙教授和 陈少华教授等人的一项最新研究结果。该研究针对影响喉鳞状细胞癌(SCC)患者预后的几个至关重要的因素进行了考察。

    研究人员根据临床及随访数据，对205例喉SCC患者进行了回顾性分析，这些患者曾于广东省人民医院接受过全喉切除、部分喉切除或CO₂激光手术治疗。通过Kaplan-Meier方法，对患者生存率进行了分析，并根据Cox比例风险模型，对预后因素进行了多变量分析。

    研究结果表明，在喉癌亚型方面，69.8%的患者为声门型，30.2%的患者为声门上型。多数患者为N0期(77.6%)，22.4%的患者为N1∼N3期。超过半数(55.1%)的患者为T1∼T2期，20.0%为T3期，24.9%为T4期。平均随访时间为49.2个月。患者在术后1年、2年及3年的生存率分别99.0%、91.7%及 81.5%。IV期患者的生存率明显低于I期及II期患者(p<0.001及p = 0.013)。患者在术后1年、2年及3年的无病生存率分别为83.9%、74.6%及71.2%。与Charlson评分为0的患者相比，Charlson评分为1至2以及≥3的患者死亡风险较高(风险比分别为1.8 及2.41 ，p = 0.042及p = 0.008)。多变量分析表明，临床分期、手术切缘以及伴随疾病与患者死亡率和无病进展率显著相关。

    研究人员据此认为，手术切缘、临床分期及伴随疾病为影响喉癌预后的独立因素。喉癌晚期、阳性切缘或存在严重伴随疾病患者的生存率较低，这表明，尽早诊断、尽早治疗、阴性手术切缘及伴随疾病状况对于喉癌具有重要意义。

与细胞癌相关的拓展阅读： 

• Ann Surg：肝细胞癌TNM分期似应考虑肿瘤破裂因素
• JNCI：血浆25-羟维生素D浓度影响肾细胞癌发病风险
• JCO：他汀类药物可降低丙肝人群的肝细胞癌发病风险
• BJU Int：新研究可预测转移性肾细胞癌预后
• Arch Dermatol：皮肤病变部位疼痛瘙痒或为鳞状细胞癌的征兆 更多信息请点击：有关细胞癌更多资讯

Retrospective analysis of prognostic factors in 205 patients with laryngeal squamous cell carcinoma who underwent surgical treatment.
Objectives
To investigate the most important factors affecting the prognosis of the patients with squamous cell carcinoma (SCC) of the larynx.
Methods
Based on the clinical and follow-up data, 205 patients with SCC of the larynx receiving total laryngectomy, partial laryngectomy, or CO2 laser surgery in GuangDong General Hospital were retrospectively analyzed. A survival analysis was performed by the Kaplan-Meier method and a multivariable analysis of prognostic factors was carried out using the Cox proportional hazard model.
Results
Subtypes of carcinoma included 69.8% glottic and 30.2% supraglottic. Most patients were in N0 stage (77.6%), and 22.4% patients were in N1~N3 stage. Over half of the patients were in T1~T2 stage (55.1%), 20.0% in T3, and 24.9% in T4. Mean follow-up duration was 49.2 months. The survival rates 1, 2, and 3 years after the surgery were 99.0%, 91.7%, and 81.5%, respectively. The survival rate for those patients with clinical stage IV was significantly lower than for those with clinical stage I and II (p<0.001 and p = 0.013, respectively). The disease-free progression rates 1, 2, and 3 years after the surgery were 83.9%, 74.6%, and 71.2%, respectively. Futhermore, those patients with a Charlson score of 1 to 2 and ≥3 had higher risk of mortality than those with a Charlson score of 0 (hazard ratios of 1.8 and 2.41 p = 0.042 and p = 0.008). Multivariable analysis revealed that clinical stage, surgical margin, and comorbidity were significantly associated with both mortality and disease-free progression.
Conclusion
The surgical resection margin, clinical stage, and comorbidity were independent factors affecting the laryngeal cancer prognosis. The survival rates were lower for patients with advanced laryngeal cancer, positive surgical margins, or severe comorbidity, suggesting the importance of early diagnosis, early treatment, negative surgical margins, and conditions of comorbidity.