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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(Waldχ~2=11.900,P=0.002;Waldχ~2=4.874,P=0.021;Waldχ~2=6.588,P=0.012;Waldχ~2=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 investigate the effect of neoadjuvant chemotherapy on postoperative prognosis of patients with advanced oral cancer and to analyze the related factors. Methods: The clinical data of 96 patients with advanced oral cancer treated in our hospital from July 2009 to June 2012 were retrospectively analyzed. Among them, 46 patients had no neoadjuvant chemotherapy before operation, which was the control group. The other 50 patients underwent neoadjuvant chemotherapy before operation, which was the observation group. The clinical efficacy, adverse reactions and survival rate of the two groups were compared, and the correlation analysis of prognostic factors was performed. Results: The total effective rate in observation group was 80.0%, which was significantly higher than that in control group (54.3%), the difference was statistically significant (P <0.05). In the control group, the number of TNM staging decreased by 1, decreased by 2, decreased by 3, and decreased by 21, 15, and 10 respectively. The number of TNM staging decreased by 1, decreased by 2, decreased by 3, By rank sum test, the difference between the two groups was statistically significant (u = 5.36, P <0.05). The incidence of nausea and vomiting and leukopenia in the observation group was 94.0% (47/50), which was significantly higher than that in the control group [32.6% (15/46)]. The difference was statistically significant (P <0.05). There was no significant difference in the incidence of oral mucositis, diarrhea, anemia and liver dysfunction between the two groups (P> 0.05). The 2-year survival rate was 74.0% (37/50) in the observation group and no significant difference compared with 69.5% (32/46) in the control group (P> 0.05). The 3-year survival rate in the observation group was 58.0% (29/50), which was significantly higher than that of the control group [34.8% (16/46)], the difference was statistically significant (P <0.05). The median survival time was 30 months in the observation group and 21 months in the control group, the difference was statistically significant (P <0.05). Fifty-six patients with free flap tissue defect repair had a median survival time of 33 months. The remaining 40 patients had no repair and the median survival time was 26 months. The difference was statistically significant ( P <0.05). Important factors affecting the prognosis of patients with advanced oral cancer include treatment, lymph node metastasis, free flap repair, and surgical margin (Waldχ 2 = 11.900, P = 0.002; Waldχ 2 = 4.874, P = 0.021; Waldx 2 = 6.588 , P = 0.012; Waldχ ~ 2 = 3.942, P = 0.045). Conclusion: Neoadjuvant chemotherapy can significantly improve the efficacy of patients with advanced oral cancer and prolong the survival time of patients. The independent risk factors for prognosis of patients with advanced oral cancer were lymph node metastasis, free flap repair and surgical margin.