咽部梭形细胞鳞状细胞癌的临床及预后分析

doi:10.6040/j.issn.1673-3770.0.2023.216

摘要/Abstract

摘要： 目的探讨咽部梭形细胞鳞状细胞癌的临床病理特征、诊断、治疗及预后,以提高对该肿瘤的诊疗水平。方法对美国SEER数据库的患者数据与南京医科大学第一附属医院2014年至2021年收治的咽部梭形细胞鳞状细胞癌患者进行回顾性分析。将SEER数据库中的梭形细胞鳞状细胞癌患者与普通型鳞状细胞癌患者的数据进行倾向得分匹配(propensity score matching, PSM),产生配对数据后采用Kaplan-Meier进行生存分析,分析2组间总生存期差异;并采用卡方检验、Cox风险比例模型分析临床危险因素与预后的关系。结果本院7例患者均为男性,平均年龄60岁,其中下咽部病例5例,鼻咽部病例2例。治疗以手术为主,辅助放化疗。数据库资料经PSM后生存分析显示,咽部梭形细胞鳞状细胞癌患者生存率明显差于普通型鳞状细胞癌,差异具有统计学意义(χ2=61.84,P<0.001)。单因素回归分析显示种族、TNM分期、T分期和M分期与总生存时间有关(P<0.05);多因素回归分析显示种族与M分期是影响咽部梭形细胞鳞状细胞癌患者总生存时间的独立危险因素(P<0.05)。结论咽部梭形细胞鳞状细胞癌较普通型鳞状细胞癌罕见且预后差,种族与远处转移是影响预后的独立危险因素。临床上对该类患者应采取以根治性手术切除为主的综合治疗模式,并定期复查,终身随访。

关键词: 头颈部肿瘤, 咽部, 梭形细胞鳞状细胞癌, 倾向得分匹配, 预后因素分析

Abstract: Objective To investigate the clinicopathological features, diagnosis, treatment and prognosis of patients with spindle cell squamous carcinoma, in order to improve the level of diagnosis and treatment of this tumor. Methods Between 2014-2021, patients from the First Affiliated Hospital of Nanjing Medical University with spindle cell squamous cell carcinoma were analyzed alongside patient data from the SEER database of America retrospectively. The propensity score matching(PSM)analysis was performed between patients with spindle cell squamous cell carcinoma and those with squamous cell carcinoma in the SEER database, and Kaplan-Meier survival analysis was performed to analyze the difference in overall survival between the two groups. Chi-square test and Cox risk model were used to analyze the relationship between clinical risk factors and prognosis. Results All patients were male with an average age of 60, including 5 cases of hypopharynx and 2 cases of nasopharynx. The main treatment is surgery, accompanied by chemoradiotherapy. Survival analysis after PSM showed that the survival rate of spindle cell squamous carcinoma of pharynx was significantly worse than common squamous cell carcinoma(χ2=61.84, P<0.001). Univariate analysis showed that race, TNM stage, T stage and M stage were related to overall survival(P<0.05). Multivariate regression analysis showed that race and M stage were independent prognostic factors for patients with spindle cell squamous carcinoma of pharynx(P<0.05). Conclusion Spindle cell squamous carcinoma of pharynx is rarer than common squamous cell carcinoma with poor prognosis. Race and distant metastasis are important prognostic indicators. And comprehensive treatment mode, regular review and lifelong follow-up should be adopted for these patients.

Key words: Head and neck neoplasms, Pharynx, Spindle cell squamous cell carcinoma, Propensity score matching, Prognostic factor analysis

中图分类号:

R766

黄佳丽,刘梓琪,徐娟,陈曦,张立庆,周涵. 咽部梭形细胞鳞状细胞癌的临床及预后分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 94-100.

HUANG Jiali, LIU Ziqi, XU Juan, CHEN Xi, ZHANG Liqing, ZHOU Han. Clinical and prognostic analysis of spindle cell squamous carcinoma of pharynx[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(2): 94-100.

参考文献

[1] Rotsides JM, Patel E, Oliver JR, et al. Non-squamous cell malignancies of the larynx[J]. Laryngoscope, 2022, 132(9): 1771-1777. doi:10.1002/lary.30007
[2] Rosko AJ, Birkeland AC, Wilson KF, et al. Tumor biomarkers in spindle cell variant squamous cell carcinoma of the head and neck[J]. Otolaryngol Head Neck Surg, 2016, 155(1): 106-112. doi:10.1177/0194599816636612
[3] Neha B, Shashi D, Seema R. Spindle cell squamous cell carcinoma of head and neck region: a clinicopathological and immunohistochemical study[J]. Indian J Surg Oncol, 2021, 12(4): 699-705. doi:10.1007/s13193-021-01418-1
[4] Palla B, Suhaym O, Majeed N, et al. Spindle cell variant squamous cell carcinoma of the oral cavity: case presentation and review of literature[J]. Oral Maxillofac Surg Cases, 2020, 6(3): 100174. doi:10.1016/j.omsc.2020.100174
[5] 王玉红, 王倩, 陈萍, 等. 原发于喉部的非鳞状细胞癌11例并文献复习[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 83-88.doi: 10.6040/j.issn.1673-3770.0.2014.302 WANG Yuhong, WANG Qian, CHEN Ping, et al. Clinical analysis of primary laryngeal non-squamous cell carcinoma(11 cases report)[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2015, 29(1): 83-88.10.6040/j.issn.1673-3770.0.2014.302
[6] Dai LY, Fang QG, Li P, et al. Oncologic outcomes of patients with sarcomatoid carcinoma of the hypopharynx[J]. Front Oncol, 2019, 9: 950. doi:10.3389/fonc.2019.00950
[7] Chen L, Chen Q, Li C, et al. Clinical analysis of laryngeal spindle cell carcinoma[J]. ORL J Otorhinolaryngol Relat Spec, 2020, 82(6): 310-317. doi:10.1159/000508134
[8] 姜超, 周炫辰, 韩杰, 等. IVc期下咽癌特征分析及列线图预后模型构建[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 49-54. doi:10.6040/j.issn.1673-3770.0.2021.278 JIANG Chao, ZHOU Xuanchen, HAN Jie, et al. Prevalence and prognostic nomogram for IVc stage hypopharyngeal carcinoma patients: a SEER popula-tion-based analysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 49-54. doi:10.6040/j.issn.1673-3770.0.2021.278
[9] Fasunla AJ, Ogundoyin OA, Onakoya PA, et al. Malignant tumors of the larynx: Clinicopathologic profile and implication for late disease presentation[J]. Niger Med J, 2016, 57(5): 280-285. doi:10.4103/0300-1652.190596
[10] Chen HB, Gong XY, Li W, et al. Genomic landscape and tumor mutation burden analysis of Chinese patients with sarcomatoid carcinoma of the head and neck[J]. Oral Oncol, 2021, 121: 105436. doi:10.1016/j.oraloncology.2021.105436
[11] 田艳华, 苏凯, 王三春, 等. 咽喉部肉瘤样癌5例报告及文献复习[J]. 吉林大学学报(医学版), 2019, 45(3): 697-700. doi:10.13481/j.1671-587x.20190339 TIAN Yanhua, SU Kai, WANG Sanchun, et al. Sarcomatoid carcinoma of throat: a report of 5 cases and literature review[J]. Journal of Jilin University(Medicine Edition), 2019, 45(3): 697-700. doi:10.13481/j.1671-587x.20190339
[12] Ding L, Bi ZF, Yuan H, et al. Sarcomatoid carcinoma in the head and neck: a population-based analysis of outcome and survival[J]. Laryngoscope, 2021, 131(2): E489-E499. doi:10.1002/lary.28956
[13] 卢晶, 金仁顺. 咽喉部梭形细胞癌临床病理特点及免疫组织化学特征分析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(22): 1748-1750. doi:10.13201/j.issn.1001-1781.2018.22.016 LU Jing, JIN Renshun. Clinicopathological features and immunohistochemical characteristic analysis of spindle cell carcinoma of the larynx[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(22): 1748-1750. doi:10.13201/j.issn.1001-1781.2018.22.016
[14] Dubal PM, Marchiano E, Kam D, et al. Laryngeal spindle cell carcinoma: a population-based analysis of incidence and survival[J]. Laryngoscope, 2015, 125(12): 2709-2714. doi:10.1002/lary.25383
[15] Bice TC, Tran V, Merkley MA, et al. Disease-specific survival with spindle cell carcinoma of the head and neck[J]. Otolaryngol Head Neck Surg, 2015, 153(6): 973-980. doi:10.1177/0194599815594360
[16] Duprez F, Berwouts D, De Neve W, et al. Distant metastases in head and neck cancer[J]. Head Neck, 2017, 39(9): 1733-1743. doi:10.1002/hed.24687
[17] Prieto-Granada CN, Xu B, Alzumaili B, et al. Clinicopathologic features and outcome of head and neck mucosal spindle cell squamous cell carcinoma[J]. Virchows Arch, 2021, 479(4): 729-739. doi:10.1007/s00428-021-03117-2
[18] Feng L, Cai D, Muhetaer A, et al. Spindle cell carcinoma: the general demographics, basic clinico-pathologic characteristics, treatment, outcome and prognostic factors[J]. Oncotarget, 2017, 8(26): 43228-43236. doi:10.18632/oncotarget.18017
[19] Spector ME, Wilson KF, Light E, et al. Clinical and pathologic predictors of recurrence and survival in spindle cell squamous cell carcinoma[J]. Otolaryngol Head Neck Surg, 2011, 145(2): 242-247. doi:10.1177/0194599811402167
[20] Dubal PM, Marchiano E, Kam D, et al. Laryngeal spindle cell carcinoma: a population-based analysis of incidence and survival[J]. Laryngoscope, 2015, 125(12): 2709-2714. doi:10.1002/lary.25383

相关文章 15

[1]	王登茂,温鑫,耿江桥,张光远,刘晓峰. 儿童咽鼓管毛息肉合并鼻咽部错构瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 105-109.
[2]	张静祎,董湘依,牟亚魁,宋西成. 细胞焦亡在耳鼻咽喉科疾病中的研究进展[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 140-148.
[3]	马静,张敏,朱歆洁. 青少年口咽部畸胎瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(2): 89-97.
[4]	任晓勇. 阻塞性睡眠呼吸暂停合并症的研究现状和未来展望[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 1-5.
[5]	姚钰宁,张龙生,孙静,曹克刚. 《伤寒论》苦酒汤治疗难治咽部溃疡1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 68-73.
[6]	钟佳珂,王柏杨,伊海金. 以耳部症状首发、合并鼻咽占位的肉芽肿性多血管炎1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(1): 6-14.
[7]	韩书慧, 范新泰, 王娜, 王喆, 侯凌霄, 许安廷. 基于倾向得分匹配研究乳突气化程度与内淋巴囊发育的关系[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 22-26.
[8]	朱华明,关建,茆松,张维天,易红良. 低温等离子射频消融辅助咽旁间隙良性肿瘤切除的应用分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 28-33.
[9]	敬前程,龚巍,周定刚,周芳. 咽部放线菌病6例临床分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 54-57.
[10]	边晓敏, 韩光红, 于丹. 细胞外囊泡在头颈部肿瘤中的研究进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 99-104.
[11]	冯剑,周涵,宋圣花,赵青,张佳程,刘雅琴,沈宇杰,董伟达. 鼻腔鼻窦腺样囊性癌15例临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 87-91.
[12]	刘坤,张欣欣. 循环肿瘤细胞在头颈部鳞癌中的富集及检测[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 18-24.
[13]	陈曦,乔明哲. 免疫检查点抑制剂在复发或转移性头颈鳞癌的治疗进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 42-48.
[14]	王刚,吴玮,王磊,刘红丹,徐小杭,徐冰心,丁瑞英,周莹,韩浩伦,龚敬,李保卫,孙喆喆. Ryan指数与反流症状指数量表、反流体征量表在咽喉反流性疾病诊断中的相关性分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 48-52.
[15]	薛荣,张希龙. 咽部肌肉和结构与阻塞性睡眠呼吸暂停的关系[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 9-12.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed