新辅助化疗对晚期口腔癌患者术后预后的影响及相关影响因素分析-现代医学

新辅助化疗对晚期口腔癌患者术后预后的影响及相关影响因素分析

单位：榆林市第一医院口腔科, 陕西榆林 719000

分类号：R739.8

出版年·卷·期（页码）：2017·36·第四期（486-490）

摘要：

目的：探讨新辅助化疗对晚期口腔癌患者术后预后的影响，并分析相关影响因素。方法：回顾性分析2009年7月至2012年6月于我院进行医治的96例晚期口腔癌患者的临床资料。其中46例患者术前未行新辅助化疗，为对照组；另50例患者术前行新辅助化疗，为观察组。比较两组患者的临床疗效、不良反应以及生存率，并对预后影响因素进行相关性分析。结果：观察组患者的总有效率为80.0%，明显高于对照组的54.3%，差异有统计学意义（P<0.05）。对照组TNM分期降1期、降2期、降3期例数分别为21、15、10例，观察组降1期、降2期、降3期例数分别为10、26、14例，经秩和检验，两组患者降期人数差异具有统计学意义（u=5.36，P<0.05）。观察组患者恶心呕吐和白细胞减少的发生率为94.0%（47/50），明显高于对照组[32.6%（15/46）]，差异有统计学意义（P<0.05）。两组患者口腔黏膜炎、腹泻、贫血、肝功能损害的发生率比较，差异无统计学意义（P>0.05）。观察组组患者2年生存率为74.0%（37/50），与对照组[69.5%（32/46）]比较差异无统计学意义（P>0.05）；观察组3年生存率为58.0%（29/50），明显高于对照组[34.8%（16/46）]，差异有统计学意义（P<0.05）。观察组患者中位生存时间为30个月，对照组患者中位生存时间为21个月，差异有统计学意义（P<0.05）。行游离皮瓣组织缺损修复术患者共56例，中位生存时间为33个月；其余40例患者未行该修复术，中位生存时间为26个月，两者比较差异具有统计学意义（P<0.05）。影响晚期口腔癌患者预后的重要因素包括治疗方式、淋巴结转移、游离皮瓣修复、手术切缘（Wald χ²=11.900，P=0.002；Wald χ²=4.874，P=0.021；Wald χ²=6.588，P=0.012；Wald χ²=3.942，P=0.045）。结论：新辅助化疗能够显著提高晚期口腔癌患者疗效，延长患者生存时间。晚期口腔癌患者预后的独立危险因素为淋巴结转移、游离皮瓣修复、手术切缘。

Objective: To explore the effect of neoadjuvant chemotherapy on prognosis of advanced oral cancer patients after surgery, andanalyse the prognosis factors.Methods: 96 cases of advanced oral cancer patients treated in our hospital between July 2009 and June 2012 were randomly divided into the control group(n=46) and the observation group(n=50). Patients in the control group weren't given neoadjuvant chemotherapy before surgery, while patients in the observation group were given neoadjuvant chemotherapy before surgery. The curative effect, side effects and survival rate of two groups were compared, and the prognosis factors were analysed.Results: The total effective rate of the observation group were 80.0%, significantly higher than that of the control group (54.3%) (P<0.05).Down one, down two, down three stage of TNM of control group were 21,15,10 cases and down one, down two, down three stage of TNM of observation group were 10,26,14 cases. By rank and testing,there was significant differences between the two groups (u=5.36, P<0.05), with statistical significance. The incidence of nausea and vomiting and white blood cell reduction in the observation group was 94.0%(47/50), significantly higher than that in the control group[32.6%(15/46)], with statistically significant (P<0.05). There was no significant difference in the incidence of oral mucosal inflammation, diarrhea, anemia and liver function between the two groups (P>0.05). 2 year survival rate of patients in observation group was 74.0%(37/50), and that in the control group was 69.5%(32/46), with no significant difference (P>0.05); 3 years survival rate of observation group was 58.0%(29/50), higher than that of the control group[34.8%(16/46)],with statistically significant (P<0.05).Median survival time was 30 months in observation group, and median survival time of control group was 21 months, with statistically significant (P<0.05). The free flap to repair tissue were used in 56 cases, whose median survival time was 33 months; for the other 40 caseswithout the repair, the median survival time of whom was 26 months, with significant difference (P<0.05).the important factors that influenced the prognosis of advanced oral cancer included treatment pattern, lymph node transfer, free skin flap repair, surgical margin(Wald χ²=11.900,P=0.002;Wald χ²=4.874,P=0.021;Wald χ²=6.588,P=0.012;Wald χ²=3.942,P=0.045). Conclusion: Neoadjuvant chemotherapy could improve the curative effect, and prolong survival time of advanced oral cancer patients. Regional lymph node metastasis, flap application and resection margin are independent risk factors of prognosis.

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