鼻腔鼻窦腺样囊性癌88例临床分析

目的 总结鼻腔鼻窦腺样囊性癌的临床特征和治疗方法,探讨影响鼻腔鼻窦腺样囊性癌患者预后的因素.方法 总结中山大学肿瘤防治中心头颈外科1975年11月至2003年8月收治的88例原发于鼻腔鼻窦的腺样囊性癌患者的临床及病理资料,回顾性分析单纯手术、单纯放疗与放疗结合手术、化疗等治疗方式的疗效.对其治疗与预后进行统计分析.生存分析采用Kaplan-Meier法,组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型.结果 就诊时56例鼻腔鼻窦腺样囊性癌患者为Ⅲ、Ⅳ期病变,治疗多采用手术+放疗.全组患者的5年、10年、15年生存率分别为0.640、0.341、0.190;Ⅲ期患者的5年、10年生存率分别为0.833、0.221;Ⅳ期患者的5年、10年生存率分别为0.323、0.145.手术+放疗组、单纯手术组及单纯放疗组的5年、10年生存率分别为0.761、0.415,0.750、0.367,0.286、0.143.结论 鼻腔鼻窦腺样囊性癌的治疗应以综合治疗为主,临床分期及治疗方式是影响鼻腔鼻窦腺样囊性癌患者预后的独立因素.

Clinical study of 88 cases of adenoid cystic carcinoma in nasal cavity and paranasal sinuses

Objective To study the clinical characters, diagnosis, management and prognosis of patients with adenoid cystic carcinoma in nasal cavity and paranasal sinuses. Methods The data were analyzed retrospectively for 88 patients with adenoid cystic carcinoma in nasal cavity and paranasal sinuses, to evaluate the clinical characters, diagnostic and therapeutical aspects and the contribution of every factor influencing the survival Survival analysis was performed by Kaplan-Meier method, comparison among/ between groups was performed using Log-nmk test, and multivariate analysis was carried out using Cox proportional hazard model. Results There were 56 patients in stage Ⅲ and Ⅳ. Most of them received surgical operation combined with radiotherapy . The 5-year, 10-year and 15-year survival rates were 0.640, 0.341 and 0.190 respectively. While there were only 0.833,0.221 and 0.323,0.145 in stage Ⅲ and stage Ⅳ lesions respectively. The 5-year and 10-year survival rates of 0.761,0.415 were obtained in patients who received surgery combined with radiotherapy, 0. 750,0.367 and 0.286,0.143 respectively in those treated by surgery and by radiotherapy alone. Conclusions Advanced adenoid cystic carcinoma should be treated by combined surgical operation and radiotherapy. Stage and treatment approach are the independent factors affecting the prognoses of patients with adenoid cystic carcinoma in nasal cavity and paranasal sinuses.