鼻腔鼻窦腺样囊性癌40例临床分析

目的 总结鼻腔鼻窦腺样囊性癌的临床特点及治疗方法,对其预后及影响因素进行分析.方法 回顾性分析中国医学科学院肿瘤医院1994-2003年40例鼻腔鼻窦腺样囊性癌患者临床资料,采用Kaplan-Meier法和Log-rank检验分析其生存率、复发及远处转移特点.结果 鼻腔鼻窦腺样囊性癌原发于上颌窦者最多见,占80%.全部患者5年及10年生存率分别为76.9%和61.6%;5年和10年的无瘤生存率分别为44.2%和23.0%.5年复发率及远处转移率分别为45.0%和23.0%.肺转移是远处转移的主要方式,远处转移的出现和生存率下降密切相关(χ2=7.26,P=0.007).术前放疗患者远处转移发生率(18.2%)低于术后放疗者(38.9%),但差异无统计学意义(χ2=1.37,P=0.24).对复发患者采取以手术治疗为主的综合治疗,复发后5年生存率为60.0%.结论 远处转移可能是影响患者预后的重要因素;手术+放疗的综合治疗是治疗腺样囊性癌的主要治疗方式,放疗在鼻腔鼻窦腺样囊性癌的治疗中有重要作用;积极采取以手术为主的综合治疗方式,可有效延长复发患者的生存期,提高生存率.

Clinical analysis of 40 cases with sinonasal adenoid cystic cardnoma

Objective To study the clinical characters and the mode of treatment, and to analyze the prognosis of patients with sinonasal adenoid cystic carcinoma. Methods The clinical data were analyzed retrospectively in 40 patients with sinonasal adenoid cystic carcinoma. The characters of survival rate, local recurrence and distant metastasis in these patients were analyzed using Kaplan-Meier method and Log-rank test. Results The maxillary sinus was the most common site of origin and account for 80% of all patients. Five-year and ten-year overall survival rate were 76.9% and 61.6% respectively. Five-year and ten-year disease-free survival rate were 44. 2% and 23.0%. Five-year local recurrence rate and distant metastasis rate were 45.0% and 23.0%, respectively. The most common site of distant metastasis was lung. Presence of distant metastasis correlated with decreased 5-year survival (χ2= 7.26, P = 0.007). The distant metastasis rate of preoperative treatment (18.2%) seemed lower than that of postoperative treatment (38. 9%), but there was no significant difference in the two groups (χ2 = 1.37, P = 0.24). The combined therapy mainly composed of surgery was adopted to treat the local recurrence. Five-year survival rate after development of local recurrence was 60. 0%. Conclusions Distant metastasis is an important factor affecting the prognosis of the patients with sinonasal adenoid cystic carcinoma. Combined therapy composed of surgery and radiation was the first choice of treatment to the patients with sinonasal adenoid cystic carcinoma. Radiation can play an important role in the treatment. The combined therapy mainly composed of surgery should be adopted in the patients with local recurrence to improve the survival rate.