187例中国嗅神经母细胞瘤的治疗疗效和预后因素分析

发布时间：2018-10-21 15:54

【摘要】：目的:分析中国人群中嗅神经母细胞瘤(esthesioneuroblastoma,ENB)的治疗疗效及预后因素。方法:以"嗅神经母细胞瘤"为关键字在CNKI和万方数据库中进行检索,检索时限为1981-2015年。从病例报道和病例分析研究中共收集187例ENB病例,全部按Kadish分期标准进行分期,Kaplan-Meier法计算生存率。结果:研究共纳入187位ENB患者,中位随访时间为24个月(1~204个月),患者的2年总生存率(overall survival,OS)为75.4%,2年无病生存率(disease-free survival,DFS)为52.9%。Kadish临床分期A期、B期、C期患者的2年OS分别为92%、96%、62.5%(χ2=21.724,P=0.000),2年DFS分别为72%、66%、42.9%(χ2=14.874,P=0.000)。以手术联合放疗为主的综合治疗模式和其他治疗模式(包括单纯放疗、单纯手术、放疗+化疗、姑息治疗)的2年OS分别为84.5%和60.6%(χ2=15.283,P=0.000),2年DFS分别为63.8%和35.2%(χ2=15.907,P=0.003)。有颈部淋巴结转移(N+)和无颈部淋巴结转移(N0)的2年OS分别为53.1%和80%(χ2=12.614,P=0.000),2年DFS分别为34.4%和56.8%(χ2=8.722,P=0.003)。复发是治疗失败的主要模式,其中以远处转移预后最差。在187例患者中共有64例患者出现复发,复发率为34.2%,其中C期49例(43.8%),增加化疗并不能减少C期患者的复发率,但颈部淋巴结清扫能减少N+患者的复发率。结论:手术联合放疗为主的综合治疗仍是目前ENB最佳的治疗模式,影响生存的主要因素为Kadish分期、治疗方式、复发和淋巴结情况,化疗的影响仍需进一步深入研究。
[Abstract]:Objective: to analyze the therapeutic effect and prognostic factors of olfactory neuroblastoma (esthesioneuroblastoma,ENB) in Chinese population. Methods: using "olfactory neuroblastoma" as the key word, the search time was 1981-2015 in CNKI and Wanfang database. A total of 187 cases of ENB were collected from case report and case analysis. All of them were staging according to Kadish staging criteria. Survival rate was calculated by Kaplan-Meier method. Results: the median follow-up time was 24 months (1-204 months), the overall 2-year survival rate (overall survival,OS) was 75.4, the 2-year disease-free survival rate (disease-free survival,DFS) was 52.9%.Kadish clinical stage A, stage B, stage C, the 2-year OS was 62.5% (蠂 221.724 P 0.000), and the 2-year DFS was 72.2% (蠂 214.874P 0.000). The 2-year OS of combined operation combined with radiotherapy was 84.5% and 60.6% respectively (蠂 2 15.283 P 0.000) and DFS of 2 years was 63.8% and 35.2% respectively (蠂 2 15.907 P 0.003). The OS of 2 years with cervical lymph node metastasis (N) and without cervical lymph node metastasis (N0) were 53.1% and 80%, respectively (蠂 2, 12.614%, 0.000), and the 2-year DFS were 34.4% and 56.8%, respectively (蠂 2: 8.722 P, P 0. 003). Recurrence is the main mode of failure, and distant metastasis has the worst prognosis. The recurrence rate was 34.2in 64 out of 187 patients, 49 (43.8%) of whom were in stage C. increased chemotherapy could not reduce the recurrence rate of stage C, but neck lymph node dissection could reduce the recurrence rate of N patients. Conclusion: combined surgery combined with radiotherapy is still the best treatment mode for ENB at present. The main factors affecting survival are Kadish stage, treatment mode, recurrence and lymph node status. The effect of chemotherapy needs further study.
【作者单位】： 南昌大学第二附属医院肿瘤科;
【基金】：国家自然科学基金资助项目(编号:81560509)
【分类号】：R739.4
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本文编号：2285603