[Treatment and prognosis of 264 patients with hypopharyngeal carcinoma].

Objective: To investigate the key factors influencing the prognosis of hypopharyngeal carcinoma and the therapeutic methods improving the efficacy of treatments for hypopharyngeal carcinoma. Methods: Two hundred and sixty-four cases of hypopharyngeal squamous cell carcinoma treated from May 2010 to May 2015 were analyzed retrospectively. There were 211 cases of pyriform sinus carcinoma, 37 cases of posterior pharyngeal wall carcinoma, and 16 cases of postcricoid carcinoma. According to UICC 2002 criteria, 2 cases were for stage Ⅰ, 14 for stage Ⅱ, 32 for stage Ⅲ and 216 for stage Ⅳ. Postoperative circumferential defects existed in 112 (42.4%) cases, and 86 of them were reconstructed with free jejunum transplantation. Among all cases, 54 patients (20.5%) had the preservation of laryngeal functions after surgery and 210 patients (79.5%) with total laryngectomy; 238 cases (90.2%) underwent bilateral cervical lymph node dissection and 203 patients received posterior pharyngeal lymph node exploration and dissection, with positive metastases for posterior pharyngeal lymph nodes in 36 cases (17.7%). Eight cases with cervical lymph node metastasis extensively involving the soft tissue, prevertebral fascia or encases carotid artery received preoperative radiotherapy of 50 Gy. After surgery 13 patients received concurrent radiotherapy and chemotherapy, 337 underwent adjuvant radiotherapy with a dose of 50-60 Gy each, and 14 patients did not receive radiotherapy or did not completed their radiotherapy programs. SPSS 13.0 saftware was used to analyze the data. Results: All patients were followed up for more than 2 years. With Kaplan-Meier method, the 2-, 3- and 5-years survival rates were 69.6%, 62.8% and 51.3%, respectively. There were significant differences in 3-year survival rates between T1-2 group (75.5%) and T3-4 group (59.2%) (χ(2)=4.282 P=0.039), N0 group (81.6%) and N+ group (58.2%) (χ(2)=6.802 P=0.009), laryngeal functions preserved (81.8%) and unpreserved group (58.9%) (χ(2)=5.314 P=0.021). Multivariate Logistic regression analysis showed that cervical lymph node metastasis was an independent prognostic factor (P=0.027). The success rate of free jejunum transplantation was 98.8%. Local recurrence, cervical lymph node recurrence, second primary cancer, and distant metastasis accounted respectively for 11.2%, 18.8%, 12.5% and 45.0% of death cases. Conclusions: The prognosis-associated factors for hypopharyngeal carcinoma should be taken into account, including the evaluation of the carcinogenesis of the mucosal area, early screening of premalignant lesion or second primary cancer in the esophagus and dissection of the posterior pharyngeal lymph nodes, which will help to improve the local control rate and recent survival rate in patients with hypopharyngeal cancer.目的：分析影响下咽癌患者预后的关键因素，探讨提高下咽癌疗效的改进措施。 方法：回顾性分析2010年5月至2015年5月山东大学附属省立医院耳鼻咽喉头颈外科收治的264例原发下咽鳞状细胞癌患者的临床资料，其中梨状窝癌211例，下咽后壁癌37例，环后癌16例；Ⅰ期2例，Ⅱ期14例，Ⅲ期32例，Ⅳ期216例；原发灶切除方式中行下咽环周切除者112例(42.4%)，其中游离空肠移植修复共86例。喉功能保留者54例(20.5%)，喉全切除者共210例(79.5%)。238例(90.2%)行双侧颈淋巴清扫，203例患者行咽后淋巴结探查及清扫，术后病理证实咽后淋巴结阳性36例，占17.7%。8例颈部转移灶明显外侵者，行术前计划性放疗50 Gy。13例患者术后行同步放化疗，14例患者未放疗或未完成放疗计划，余患者均行术后辅助放疗，剂量50～60 Gy。采用SPSS 13.0软件对数据进行分析。 结果：所有患者随访满2年以上，Kaplan－Meier生存率曲线法计算2年生存率为69.6%；随访满3年者196例，3年生存率为62.8%；随访满5年者80例，5年生存率为51.3%。生存率单因素分析结果显示：T1、T2组(75.5%)与T3、T4组(59.2%)之间(χ(2)＝4.282，P＝0.039)，N0组(81.6%)与N＋组(58.2%)之间(χ(2)＝6.802，P＝0.009)，喉功能保留组(81.8%)与喉功能不保留组(58.9%)之间(χ(2)＝5.314，P＝0.021)，生存率差异均有统计学意义。多因素Logistic回归分析，颈部淋巴结是否转移是影响预后的独立危险因素(P＝0.027)。本组游离空肠移植成活率98.8%。对死亡患者进行致死原因分析，局部复发与颈部区域淋巴结复发的比例分别为11.2%及18.8%。第二原发癌致患者死亡比例为12.5%，因远处转移致死患者的比例为45.0%，为患者致死的最主要原因。 结论：影响下咽癌预后的独立危险因素是颈部淋巴转移。应针对影响下咽癌预后的关键因素进行主动干预，在局部晚期原发部位的处理、咽后淋巴清扫以及早期筛查食管第二原发肿瘤等多个层面给予重点关注，可有效提高下咽癌患者的局部控制率，提高下咽癌患者的生存率。.