眼眶腺样囊性癌的治疗与预后分析  

Analysis of treatment and prognosis of orbital adenoid cystic carcinoma

作　　者：林婷婷[1] 何彦津[1] 张虹[2] 宋国祥[2] 唐东润[3] 赵慧芬[2] 

机构地区：[1]天津医科大学眼科中心,300070 [2]天津医科大学第二医院,300070 [3]天津市眼科医院,300070

出　　处：《中华眼科杂志》2009年第4期309-313,共5页Chinese Journal of Ophthalmology

摘　　要：目的分析总结眼眶腺样囊性癌的治疗方法及影响预后的因素，为改善预后提供帮助。方法采用回顾性系列病例研究，分析1991年1月至2006年7月就诊的75例眼眶腺样囊性癌患者的手术记录、病理分型及随访记录。相关数据采用X^2检验和Fisher精确检验进行统计分析。结果眼眶实体型腺样囊性癌的2年复发率为85％（17／20）、5年复发率为100％（19／19），而腺样-管状型则分别为23．53％（8／34）和64．52％（20／31），差异有统计学意义（2年，X^2=19．14，P=0．000；5年，Fisher精确检验，P=0．003）。前者发生局部蔓延和远处转移例数亦多于后者。肿瘤切除术后放射治疗的5年复发率为70％（14／20），低于单纯手术切除的复发率92．86％（13／14）（Fisher精确检验，P=0．198）。首次手术行眶内容物剜除术的5年复发率为25％（1／4），低于复发后再行眶内容物剜除术的病例为75％（6／8）（Fisher精确检验，P=0．222），γ刀、粒子刀、化疗及生物治疗的效果不能确定。局部蔓延主要是至颅内、副鼻窦和颞窝，远处转移可到达肺、骨、肝、耳前淋巴结。5年远处转移率为25．71％（9／35），肺转移和骨转移各占33．33％（3／9）。5年生存率74．29％（26／35），死亡率25．71％（9／35），无瘤生存率37．14％（13／35），10年无瘤生存率17．14％（6／35）。最常见的死亡原因是颅内蔓延。肿瘤切除联合放射治疗可以使5年生存率提高到80％（16／20）。结论腺样囊性癌是高度恶性的眼眶肿瘤，复发率和死亡率均较高，病理分型、治疗方法均影响预后。采取综合治疗方法，可以减少复发，提高生存率。Objective To summarize the treatment outcomes of orbital adenoid cystic carcinoma and to evaluate prognostic factors. Method A retrospective case series study was performed on 75 patients with orbital adenoid cystic carcinoma treated from 1991 to 2006. Results The 2- and 5- year local recurrence rate of solid type orbital adenoid cystic carcinoma was significantly higher than that of the adeno-tubiform type [2-year, 85% （17/20） vs 23.53% （8/34）, X^2 =19.14, P=0.000; 5-year, 100% （19/19） vs 64. 52% （20/31）, Fisher＇s exact test, P = 0. 003 ]. The regional extension and distant metastasis of solid type were more than those of adeno-tubiform type. The 5-year local recurrence rate treated by postoperative radiation was lower than that treated with only surgical excision [ 70% （ 14/20 ） vs 92. 86% （ 13/14 ） ; Fisher＇s exact test, P = 0. 198 ]. The 5-year local recurrence rate in patients initially treated by orbital evisceration during the first time was lower than that of cases which evisceration procedure was used after the recurrence [25% （1/4） vs 75% （6/8）, Fisher＇s exact test, P =0.222]. Tumors may extend into intracalvarium, nasal cavity and temporal fossa. They may spread to the lung, bone, liver and lymph node. The 5-year metastasis rate was 25.71% （9/35）. Both of the lung and bone metastasis rates were 33.33% （3/9）. The overall 5-year accumulative survival was 74. 29% （ 26/35 ） , mortality was 25.71% （9/35） , and rate of survival without tumor recurrence was 37. 14% （13/35）. The 10-year disease free survival rate was 17.14% （6/35）. Patients were most likely to die with intracranial extension. Surgical excision with postoperative radiation improved the 5-year survival rate to 80% （16/20）. Conclusions Orbital adenoid cystic carcinoma is one of the most malignant tumors in the orbit. They have a high local recurrence rate and survival rate. Tumor histological types and the treatment procedure can influence the prognosis.Combined therapy may decreas

关 键 词：眶肿瘤 癌 腺样囊性 综合疗法 预后 

分 类 号：R686[医药卫生—骨科学]