摘要目的 总结分析下咽癌的基本临床特点、手术治疗效果及预后影响因素.方法 回顾性分析2003年1月至2013年6月期间复旦大学附属眼耳鼻喉科医院耳鼻喉科收治的386例下咽鳞状细胞癌病例.收集患者临床基本信息,随访术后生存情况,Kaplan-Meier法进行生存分析,Cox回归模型分析预后的独立影响因素.结果 386例患者中男370例,女16例,平均年龄(58.4±9.4)岁.肿瘤TNM分期:T1期31例,T2期83例,T3期175例,T4期97例;N0期99例,N1期74例,N2期181例,N3期32例;M0期383例,M1期3例.肿瘤临床分期:1期10例,Ⅱ期29例,Ⅲ期108例,Ⅳ期239例.5年总生存率(oS)、疾病特异生存率(DSS)和无病生存率(DFS)分别为45.8％、48.1％和46.0％.生存率的独立影响因素为T分期(P＜0.001)、N分期(P =0.003)、及第二原发癌(P=0.017),肿瘤复发的危险因素为原发肿瘤T分期和脉管癌栓(P＜0.001).结论 下咽癌恶性程度高,易发生黏膜下浸润、颈部淋巴结转移及远处转移,且发现时多属晚期,预后较差.应行全面术前检查,并根据肿瘤分期选择治疗方案.对早期下咽癌可采用保留喉功能的手术治疗,而对晚期病例则主要采取为以手术为主的综合治疗.

abstractsObjective To investigate the clinical characteristics,surgical treatment outcomes and prognostic factors of hypopharyngea] carcinoma Methods A retrospective review of the Eye & ENT Hospital of Fudan University patients' database between January 2003 and June 2013 was conducted and a total of 386 patients were enrolled in the study.Patients' clinical and oncological information was collected and survival rates were analyzed using Kaplan-Meier curves.Prognostic factors were evaluated with multivariate Cox model survival analysis.Results Among the 386 patients 95.9％ were males and 4.1％were females,with an average age of (58.4 ± 9.4) years.The primary tumor sites were pyriform sinus (76.7％),posterior hypopharyngeal wall (17.3％) and postcricoid region (6.0％).There were 31(8.0％),83(21.5％),175 (45.3％) and 97 (25.1％) patients with stage T1 to T4,respectively,99(25.6％),74(19.2％),181 (46.9％) and 32(8.3％) patients with stage N0 to N3,respectively,and 3 patients with distant metastasis to lung on initial diagnosis.Second primary cancers were found in 28 cases (7.3％).The 5-year overall survival (OS),disease specific survival (DSS) and disease free survival (DFS) were 45.8％,48.1％ and 46.0％ respectively according to Kaplan-Meier survival curves.Multivariate Cox regression model showed significant association between 5-year overall survival rate and T stage (P ＜ 0.001),N stage (P =0.003) and second primary tumors (P =0.017).Advanced T stage and lymphovascular invasion were associated with a higher rate of recurrence (P ＜ 0.001).Conclusions Hypopharyngeal squamous cell carcinoma has a dismal prognosis,with high rates of submucosal infiltration,cervical lymph node metastasis and distant metastasis.Treatment choices should be made according to TNM stage and overall health conditions in order to achieve ideal oncologic and functional results.Surgery with postoperative chemoradiation therapy is the main treatment for advanced-stage hypopharyngeal cancer.