晚期鼻腔鼻窦腺样囊性癌21例临床特征分析

发布时间：2018-03-19 16:29

本文选题：鼻腔鼻窦　切入点：腺样囊性癌　出处：《南方医科大学学报》2017年06期 　论文类型：期刊论文

【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 investigate the clinical features, treatment methods, prognosis and influencing factors of advanced adenoid cystic carcinoma of nasal cavity and paranasal sinuses. Methods the clinical data of 21 patients with advanced adenoid cystic carcinoma of nasal cavity and paranasal sinuses admitted to our hospital from February 2007 to May 2016 were analyzed. Including clinical manifestations, clinical staging, pathology, treatment, local recurrence, distant metastasis and prognosis, etc. The single factor survival analysis and Cox model were used to analyze the clinical factors affecting the prognosis of 21 patients. There were 10 cases of solid type with a ratio of less than 30%. The overall 5-year survival rate was 100% and 100%, respectively. There were 11 cases with solid type ratio greater than 30%. The overall 5-year survival rate was 70% and 400.10%, respectively. The difference was statistically significant (P 0.02), and the proportion of solid type was more than 30%. The prognosis of patients with poor prognosis. Log-rank test and the survival curve of covariate under the full-variable model showed that pathological classification had a significant effect on the prognosis of stage T _ 3, which was slightly better than that of stage T _ 4. The origin of maxillary sinus was slightly superior to that of sphenoid sinus, and the combination of operation and radiotherapy was superior to that of simple operation and chemotherapy alone. The results of multivariate Cox regression model showed that the pathological classification was better than that of radiotherapy and chemotherapy. Conclusion the incidence of adenoid cystic carcinoma of nasal cavity and paranasal sinus is low, the symptom is not specific, the course of disease is longer, and the early diagnosis of multiple sinuses, especially maxillary sinus, is difficult. By the time of the visit, most of the patients were advanced. The late stage patients were mainly treated by surgery combined with postoperative radiotherapy and chemotherapy. The pathological classification, course of disease, location of disease, stage, treatment method, peripheral nerve invasion, positive margin of operation, Postoperative radiotherapy dose of less than 60 Gy may be a prognostic factor in patients with advanced adenoid cystic carcinoma.
【作者单位】：南方医科大学珠江医院耳鼻咽喉头颈外科;
【基金】：国家自然科学基金青年基金(81402456) 广东省自然科学基金(2015A030313255)~~
【分类号】：R739.62

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