[1]王会刚,申聪香,陈芳,等.晚期鼻腔鼻窦腺样囊性癌21例临床特征分析[J].南方医科大学学报,2017,(06):847.
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晚期鼻腔鼻窦腺样囊性癌21例临床特征分析()
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《南方医科大学学报》[ISSN:/CN:]

卷:
期数:
2017年06期
页码:
847
栏目:
出版日期:
2017-06-20

文章信息/Info

Title:
Clinical features of advanced adenoid cystic carcinoma in the nasal cavity and paranasal sinuses: analysis of 21 cases
作者:
王会刚申聪香陈芳李冠雪王晓琪文忠
关键词:
鼻腔鼻窦腺样囊性癌晚期综合治疗预后
Keywords:
nasal cavity paranasal sinuses adenoid cystic carcinoma advanced stage comprehensive treatment prognosis
摘要:
目的探讨发生于鼻腔鼻窦晚期腺样囊性癌的临床特征、治疗方法、预后及影响因素。方法分析2007年2月~2016年5月 入住我院的21例晚期鼻腔鼻窦腺样囊性癌患者的临床资料,包括临床表现、临床分期、病理、治疗方法、局部复发、远处转移及预 后等,并结合文献进行诊疗特征分析。采用Kaplan-Meier 法和Log-rank检验进行单因素生存分析, COX模型对影响预后的临 床因素进行多因素分析。结果21例患者中,实体型占比小于30%的有10例(47.6%),1、3、5年总生存率分别为100%、100%、 71%,实体型占比大于等于30%的有11例(52.4%),1、3、5年总生存率分别为70%、40%、10%,两者差异有统计学意义(P=0.02), 且实体型占比大于等于30%的患者预后较差。Log-rank检验及全变量模型下协变量的生存曲线表明病理分型对预后具有显著 影响,T3期预后略优于T4期,源发于上颌窦略优于蝶窦,手术及放化疗综合治疗优于单纯手术及单纯放化疗。多因素Cox回归 模型分析结果显示,病理分型、病程与预后关系密切(P=0.045、0.028)。结论鼻腔鼻窦腺样囊性癌发病率较低,症状表现无特异 性,部分患者病程较长,多发鼻窦内,尤其是上颌窦,早期诊断较困难,等到就诊时多为晚期。晚期患者以手术结合术后放化疗 的综合治疗方式为主。病理分型、病程、发病部位、分期、治疗方式、周围神经侵袭,手术切缘阳性,术后放疗剂量不足60 Gy可能 是影响晚期腺样囊性癌患者预后的因素。
Abstract:
Objective To evaluate the clinical characteristics, treatment and prognosis of advanced adenoid cystic carcinoma (ACC) in the nasal cavity and paranasal sinuses. Methods Twenty-one patients with advanced ACC in the nasal cavity and paranasal sinuses were treated in our department between February, 2007 and May, 2016. The clinical manifestations, T-stage, N-status, treatment, histological grade, recurrence and distant metastasis of the tumors were analyzed. Univariate survival analysis was performed with Kaplan-Meier method and Log-rank test, and the factors affecting the prognosis of the patients were explored using multivariate analysis with Cox proportional hazard model. Results Among the 21 patients, 10 (47.6%) had ACC containing less than 30% of solid tumor tissues and their overall survival rates at 1, 3, and 5 years were 100%, 100% and 70%, respectively; in the 11 cases (52.4%) with solid tumor tissues no less than 30%, the overall survival rates at 1, 3, and 5 years were 70%, 40% and 10%, respectively, showing significant differences between the two groups (P=0.02). The Log-rank test and survival analysis using the covariate variable model curve indicated a significant impact of the pathological classification on the patients’ prognosis. The patients in T3 stage had slightly better prognosis than those in T4 stage; tumors originating from the maxillary sinus had a slightly better prognosis than those from the sphenoid sinus. Surgery combined with radiotherapy resulted in better outcomes of the patients than surgery or radiotherapy alone. Multiariable Cox regression model analysis showed that the pathological classification (P=0.045) and the disease course (P=0.028) were closely related with the prognosis of the patients. Conclusion ACC in the nasal cavity and paranasal sinuses has a low incidence without specific symptoms. Its early diagnosis can be difficult, and most of the patients are in advanced stage upon diagnosis. We recommend comprehensive treatments combining surgery, postoperative radiotherapy and chemotherapy for these patients. The pathological classification, disease course, lesion site, clinical stage, treatment approache, compromise of the peripheral nerves, status at the edge of resection, and postoperative radiotherapy dose can all be factors affecting the prognosis of patients with advanced ACC.
更新日期/Last Update: 1900-01-01