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目的:探讨诱导化疗达到病理完全缓解(pCR)对可手术切除的Ⅲ/Ⅳ期舌体鳞状细胞癌患者生存和预后的长期影响。方法:选取1996-06-2005-12期间中山大学附属肿瘤医院首治、经病理检查确诊且随访资料完整、可手术切除的73例晚期舌鳞状细胞癌患者。所有患者均行三程PF(顺铂加5-FU)方案诱导化疗加手术和(或)放疗,回顾性分析其5年总生存率、局部控制率和治疗失败的可能原因。结果:全组随访时间为1.9~188.0个月,中位随访时间70.9个月,24例患者仍存活,其中23例患者生存时间大于10年。17例(23.3%)患者达到临床完全缓解(CR),44例(60.3%)临床部分缓解(PR),12例(16.4%)肿瘤稳定或进展,总有效率为83.6%。依据手术标本,14例(19.2%)达到pCR,59例(80.8%)病理PR。单因素分析示:肿瘤大小、有无区域淋巴结转移、临床分期、不同疗效反应和有无pCR是影响患者生存的独立因素(P<0.05)。多因素分析示:颈部淋巴结转移、不同化疗疗效反应和有无pCR是影响患者预后生存的重要因素(P<0.05)。所有患者5年总体生存率(OS)为59.8%,22例(30.1%)复发,局控率为69.9%。诱导化疗临床有效(CR+PR)患者5年OS为62.5%,明显高于无效患者(41.7%)。pCR患者5年OS为92.9%,未达到pCR患者5年OS为47.9%,2组之间的生存率差异有统计学意义(P<0.05)。结论:对于可手术切除的晚期舌鳞状细胞癌,诱导化疗联合手术和(或)放疗等综合治疗方案是可行有效的治疗方法。虽然诱导化疗的缓解率有限,但有效缓解与患者较好的预后密切相关,尤其是达到pCR者。
OBJECTIVE: To investigate the long-term effects of induction chemotherapy on survival and prognosis of patients with stage III / IV tongue squamous cell carcinoma undergoing pathologic complete remission (pCR). Methods: A total of 73 patients with advanced tongue squamous cell carcinoma who were diagnosed by pathological examination and complete follow-up data were selected from 1996-06-2005-12 at the Affiliated Tumor Hospital of Sun Yat-sen University. All patients underwent three-way PF (cisplatin plus 5-FU) regimen to induce chemotherapy plus surgery and / or radiotherapy. The 5-year overall survival, local control rate and possible causes of treatment failure were retrospectively analyzed. Results: All the patients were followed up for 1.9-188.0 months. The median follow-up time was 70.9 months. Twenty-four patients survived, and 23 patients had a survival time greater than 10 years. Among the 17 patients (23.3%), clinical complete remission (CR), 44 (60.3%) partial clinical remission (PR) and 12 (16.4%) stable or advanced tumors with a total effective rate of 83.6%. According to the surgical specimens, 14 cases (19.2%) achieved pCR, 59 cases (80.8%) pathological PR. Univariate analysis showed that tumor size, regional lymph node metastasis, clinical stage, different response and presence or absence of pCR were independent prognostic factors for survival (P <0.05). Multivariate analysis showed that cervical lymph node metastasis, response to different chemotherapeutics, and presence or absence of pCR were the important factors influencing the prognosis of patients (P <0.05). The 5-year overall survival (OS) was 59.8% in all patients, and 22 (30.1%) patients relapsed with a rate of 69.9%. The 5-year OS of clinically effective (CR + PR) -induced chemotherapy was 62.5%, significantly higher than that of ineffective patients (41.7%). The 5-year OS was 92.9% in patients with pCR and 47.9% in patients who did not achieve pCR. The difference in survival between the two groups was statistically significant (P <0.05). CONCLUSIONS: It is a feasible and effective treatment for advanced tongue squamous cell carcinoma that can be surgically resected, combined with induction chemotherapy and surgery and / or radiotherapy. Although induction chemotherapy has a modest rate of response, effective remission is associated with a better patient outcome, especially with pCR.