中国癌症杂志 ›› 2016, Vol. 26 ›› Issue (3): 268-275.doi: 10.3969/j.issn.1007-3969.2016.03.011

• 论著 • 上一篇    下一篇

104例鼻腔鼻窦腺样囊性癌临床分析

朱 奕,宋新貌,燕 丽,张海燕,邹丽芬,王胜资   

  1. 复旦大学附属眼耳鼻喉科医院放疗科,上海 200031
  • 出版日期:2016-03-30 发布日期:2016-06-13
  • 通信作者: 王胜资 E-mail:shengziwang@fudan.edu.cn

Clinical analysis of 104 cases of adenoid cystic carcinoma of nasal cavity and paranasal sinuses

ZHU Yi, SONG Xinmao, YAN Li, ZHANG Haiyan, ZOU Lifen, WANG Shengzi   

  1. Department of Radiation Oncology, Shanghai Eye and ENT Hospital, Fudan University, Shanghai 200031, China
  • Published:2016-03-30 Online:2016-06-13
  • Contact: WANG Shengzi E-mail: shengziwang@fudan.edu.cn

摘要: 背景与目的:腺样囊性癌是一种来自于涎腺组织的少见肿瘤,占所有头颈部恶性肿瘤的1%~2%。鼻腔鼻窦腺样囊性癌的发病率较低,且生长缓慢,较少淋巴转移,但是容易侵犯临近组织和沿着神经浸润生长,后期有较高的复发率和远处转移率,往往预后不佳。该研究总结鼻腔鼻窦腺样囊性癌的临床及病理特点,并对其预后和影响因素进行分析。方法:该研究为一项单中心、回顾性的研究,分析了104例2000年9月—2012年11月间在复旦大学附属眼耳鼻喉科医院接受过放疗的鼻腔鼻窦腺样囊性癌患者,中位随访时间5.1年。使用Kaplan-Meier、log-rank检验和COX比例风险模型进行生存相关的数据分析。结果:患者平均年龄(54.5±11.5)岁,男女各占50%。鼻腔为最常见的原发部位(63.5%),其次为上颌窦(29.8%),临床分期以Ⅲ~Ⅳ期为主(76.0%),手术切缘阳性者为56.7%,出现神经浸润者为34.6%。术后放疗的患者占67.3%,术前放疗占27.9%,仅4.8%的患者采用了单纯放疗,其中29.8%的患者在手术和放疗基础上联合了化疗。采用CRT放疗者为81.7%,采用IMRT放疗者为18.3%。最终18例出现复发,28例出现远处转移,肺部为最常见的转移部位,神经浸润是影响复发或转移的独立危险因素(P=0.0002)。患者的5年和10年总生存率(overall survival,OS)分别为77.0% (95%CI:68.7%~85.3%)和67.8%(95%CI:57.8%~77.9%);5年和10年的无瘤生存率(disease-free survival,DFS)分别为57.8%(95%CI:48.0%~67.7%)和56.4%(95%CI:46.3%~66.4%)。复发或远处转移是显著影响OS的危险因素(未校正HR=60.1,95%CI:8.15~443.1,P<0.0001),神经浸润阳性是显著影响DFS的危险因素(未校正HR=2.99,95%CI:1.642~5.445,P=0.0002)。原发部位、临床分期、手术切缘是否阳性及放疗方式对预后无明显影响。结论:神经浸润、复发或远处转移可能是影响鼻腔鼻窦腺样囊性癌预后的重要因素。

关键词: 鼻腔鼻窦, 腺样囊性癌, 临床病理特点, 预后

Abstract: Background and purpose: Adenoid cystic carcinoma is a rare tumor from salivary gland tissues; the incidence is about 1% to 2% of all head and neck malignant tumors. The incidence of adenoid cystic carcinoma of nasal sinuses is lower. Its characteristics include slow growth, less lymph node metastasis, easy to tissue invasion and growing along the nerves. It has high rate of recurrence and distant metastasis. Patients with the disease always have poor prognosis. This study aimed to investigate the prognosis and its impacting factors in Chinese patients with adenoid cystic carcinoma of nasal cavity and paranasal sinuses. Methods: This was a single center, prospective, observational study in Chinese patients with adenoid cystic carcinoma of nasal cavity and paranasal sinuses. Total 104 patients who received radiotherapy during the period between Sep. 2000 and Nov. 2012 were included and followed up for median 5.1 years. Kaplan-Meier, log-rank test, and COX proportional hazards model were used for survival-related analysis. Results: Mean age of patients was (54.5±11.5) years with equal numbers of males and females. The most common primary site was nasal cavity (63.5%) followed by maxillary sinus (29.8%). 76.0% of patients were at clinical stages Ⅲ-Ⅳ, 56.7% of patients with positive surgical margin and 34.6% of patients with positive nerve invasion. In terms of treatment regimens, 67.3% of patients received postoperative radiotherapy, 27.9% received preoperative radiotherapy, only 4.8% received pure radiotherapy, and 29.8% received chemotherapy combined with surgery and radiotherapy. Conformal radiation therapy (CRT) was the most common radiotherapy which was used in 81.7% of patients, followed by intensity-modulated radiation therapy (IMRT) which was used in 18.3% of patients. Finally, 18 patients had recurrence and 28 patients had distant metastasis. The most common metastatic site was lung, and nerve invasion was the independent risk factor for recurrence or metastasis (P=0.000 2). The overall survival rates of 5 and 10 years were 77% (95%CI: 68.7%-85.3%) and 67.8% (95%CI: 57.8%-77.9%), respectively. The disease-free survival rates of 5 years and 10 years were 57.8% (95%CI: 48.0%-67.7%) and 56.4% (95%CI: 46.3%-66.4%), respectively. Recurrence or distant metastasis was critical risk factor for overall survival (HR=60.1, 95%CI: 8.15-443.1, P<0.0001). Positive nerve invasion was a significant factor for disease-free survival (HR=2.99, 95%CI: 1.642-5.445, P=0.0002). The primary sites, clinical stage, status of surgical margin, or radiotherapy methods had no impact on the prognosis of patients with adenoid cystic carcinoma of nasal cavity and paranasal sinuses. Conclusion: Positive nerve invasion, recurrence or distant metastasis may be important factors affecting the prognosis of Chinese patients with adenoid cystic carcinoma of nasal cavity and nasal sinuses.

Key words: Nasal cavity and paranasal sinuses, Adenoid cystic carcinoma, Clinical and pathological features, Prognosis