Clinicopathological Research of Treatment of Hypopgaryngeal Cancer Based on Quality of Life

1.对下咽癌患者进行P53、Ki-67、PD-ECGF、VEGF检测。这些肿瘤标记物与初次治疗后无/有局部或远处复发无明显关系。这些标记物被认为不是有效的预后因素。为了获得更好的生活质量，在放疗前对下咽癌T1T2进行了激光去髓核手术。三年局部控制率、三年喉保留率和三年原因特异性生存率分别为88%、92%和92%。此外，在接受该手术的患者中，很少有患者接受气管切开术，所有患者从手术第二天起都可以口服饮食，没有一例患者因抽吸而接受全喉切除术。针对部分下咽癌患者因颈部肿瘤来源不明就诊，探讨颈部转移部位与原发灶的关系。因此，当颈转移灶为鳞状细胞癌且局限于颈上、中颈静脉区时，患侧扁桃体切除术被认为是确定原发灶的可靠方法之一。由于下咽癌有时与舌癌同时发生，故对T1T2舌癌进行了研究。因此，预防性颈淋巴清扫术只有在患者和/或他们的家人详细说明了这种治疗的优点和缺点后才会表示同意。舌骨上颈淋巴清扫术是一种令人满意的初步治疗方法。影响颈部转移的预后因素有原发灶的侵犯深度、血管侵犯和肌肉侵犯。

1. As for the patients of hypopharyngeal cancer, their p53, Ki-67, PD-ECGF and VEGF were investigated. These tumor markers had no significant relationship with absence/presence of regional or distant recurrence after the initial treatment. These markers were regarded as no effective prognostic factors.2. To acquire better quality of life, laser debulking surgery prior to radiotherapy was conducted for T1T2 carcinoma of the hypopharynx. As a result, three-year local control rate, three-year larynx conservation rate, and three-year cause specific survival rate were 88%, 92%, and 92%, respectively. In addition, in patients who had undergone this procedure, few underwent tracheostomy, all could had oral diet from the next day of the operation, and none underwent total laryngectomy due to aspiration.3. Since some patients with carcinoma of the hypopharynx visit the hospital complaining of origin unknown neck tumor, the relationship between the site of neck metastasis and primary origin was investigated. As a result, when neck metastases were squamous cell carcinomas and were confined to upper or middle jugular areas, affected-side tonsillectomy was regarded as one of reliable methods to know the primary origin.4. Since carcinoma of the hypopharynx sometimes suffered from carcinoma of the tongue simultaneously, T1T2 carcinoma of the tongue was investigated. As a result, the prophylactic neck dissection would be indicated only when the patients and/or their family approved after detailed explanation about the advantage and disadvantage of this treatment. Supra-omohyoid neck dissection would be satisfactory as an initial treatment. Prognostic factors of neck metastases were depth of the invasion, vascular invasion, and muscular invasion of the primary tumor.