外耳道及中耳鳞癌疗效分析  

Treatment outcomes in squamous cell carcinoma of external auditory canal and middle ear

作　　者：安常明[1] 李正江[1] 徐震纲[1] 高黎[2] 唐平章[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院头颈外科,北京100021 [2]中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《中华耳科学杂志》2012年第4期416-420,共5页Chinese Journal of Otology

摘　　要：目的总结外耳道和中耳鳞癌的分期方法及临床疗效。方法回顾性分析1990～2010年我院治疗的46例外耳道、中耳鳞癌患者资料,利用SPSS软件分析生存率、复发率及预后相关因素。结果 46例患者中34例外耳道癌的5年生存率为62.4%,12例中耳癌为24.7%(P=0.004)。中耳癌分期明显晚于外耳道癌,采用综合治疗的比例更高。早期外耳道癌5年生存率为85.6%,晚期为35.6%(P=0.002)。多因素分析显示临床分期是外耳道癌的独立预后因素。外耳道癌中有15例出现复发,局部控制率为65.8%,肿瘤复发后患者生存率明显下降,复发后再治患者再次复发率高。结论早期的外耳道癌可选择单一治疗方法获得良好的生存,晚期外耳道癌病变应尽可能手术切除获得安全切缘,结合放疗提高治愈率,晚期中耳癌预后较差,建议采用乳突根治术结合放疗的综合治疗。Objective This is a review on the staging and treatment outcomes of external auditory canal （EAC） and middle ear carcinomas （ME）. Methods Data from 46 patients treated in our hospital from 1990 to 2010 were reviewed ret- rospectively. Survival and local control rates were calculated with SPSS software. Results There were 34 patients with ECA and 12 with ME cancer in the study. The 5-year survival rates in patients with EAC and ME carcinomas were 62.4% and 24.7%（P=0.004）, respectively. Patients with ME carcinomas had more advanced diseases and were more likely to receive combined treatments. Cervical lymph node metastasis predicted a poor survival. Clinical stage was the only independent prognostic factor of ECA cancer. Twenty three patients had at least one recurrence during the follow-up, including 15 with ECA and 8 with ME cancers. The local control rate of ECA cancer was 65.8% after salvage treatment. Patients with recur- rent disease had a high risk for another recurrence. Conclusion Patients with early stage ECA cancer can achieve good survival with either surgery or radiotherapy alone. Combined treatment and negative resection margin may indicate im- proved survival for patients with advanced EAC cancers. Patients with advanced middle ear cancer have poor survival in spite of extensive surgery. Radical mastoideetomy and postoperative radiotherapy are recommended for these patients to minimize treatment complications.

关 键 词：中耳癌 外耳道癌 预后 综合治疗 乳突根治术 

分 类 号：R764.1[医药卫生—耳鼻咽喉科] R764.2[医药卫生—临床医学]