鼻腔筛窦鳞状细胞癌146例治疗分析

目的 回顾性分析鼻腔筛窦鳞癌不同治疗方案对患者生存率的影响,以期明确影响预后的因素并指导临床治疗.方法 回顾性分析1990-2007年中国医学科学院肿瘤医院头颈外科和头颈放疗科治疗的经病理证实的鼻腔筛窦鳞癌患者146例,其中原发于鼻腔28例,筛窦9例,鼻中隔4例,同时发生于鼻腔筛窦105例.Ⅰ期和Ⅱ期28例,Ⅲ期46例,Ⅳ期72例.术前放疗+手术41例,手术+术后放疗22例,单纯手术5例,单纯放疗78例.采用Kaplan-Meier法和Log-rank检验进行生存分析,多因素分析采用Cox回归模型.结果 146例鼻腔筛窦鳞癌总的5年生存率为49.1%,Ⅰ～Ⅱ期5年生存率为95.7%,Ⅲ期为59.8%,Ⅳ期为28.2%,差异有统计学意义(x2=24.15,P<0.05).术前放疗+手术组、手术+术后放疗组、单纯手术组及单纯放疗组5年生存率分别为57.7%、60.4%、100%和38.8%,各组间生存率差异无统计学意义(P>0.05).单纯放疗组5年生存率38.8%,综合治疗组58.4%(P=0.043).有淋巴转移患者5年生存率为21.3%,而无淋巴转移的为53.7%,差异有统计学意义(x2=12.326,P<0.05).术前放疗+手术组眶内容颅底保留率高于术后放疗和放疗后手术挽救.局部复发和远处转移是死亡的主要原因,92.2%局部复发的病例在3年内发生.Cox多因素分析得出TNM分期和病理分化是主要的预后指标.结论 鼻腔筛窦鳞癌术前放疗+手术或手术+术后放疗的综合治疗方案是有效的治疗方案,早期病例单纯手术可以获得理想的效果.

Squamous cell carcinoma of naso-ethmoid sinus: Analysis of 146 cases

Objective To evaluate the treatment outcome of different therapeutic modalities for squamous cell cacinoma of the nose and ethmoid sinus and prognostic factors. Methods One hundred and forty-six cases of squamous cell carcinoma of the nose and ethmoid sinus treated from 1990 to 2007 were reviewed. Of the 146 cases,28 were at stage Ⅰ or Ⅱ ;46 stage Ⅲ ;72 stage Ⅳ. Forty-one patients were treated with preoperative radiation plus surgery( R + S) ,22 patients with surgery plus postoperative radiation ( S + R), 5 patients with surgery alone ( SA ), 78 patients with radiotherapy alone (RA). Results The overall 5 year survival rate of 146 patients with squamous cell carcinoma of the nose and ethmoid sinus was 49. 1%. The 5 year survival rate of the patients at stage Ⅰ and Ⅱ was 95. 7% ,while the rate was 59. 8% in the patients at stage Ⅲ and 28. 2% in the patients at stage Ⅳ ( x2 = 24. 15, P < 0. 05). The 5 year survival rate was 57.7% in R+S group,60.4% in S+R group, 100% in SA group,and 38.8% in RA group,respectively(P >0. 05). The 5 years survival rate of N + patients was lower than that of NO( x2 = 12. 326,P < 0. 05). Local recurrence and distant metastasis were main causes of death. Cox analysis showed TNM stage and differentiation of tumor were independent significant prognostic factors. Conclusions The higher survival rate of patients with squamous cell carcinoma of the nose and ethmoid sinus was obtained from combined therapy R + S or S + R. SA gave ideal results for early lesions(stage Ⅰ and Ⅱ ).