嗜神经侵袭阳性鼻腔副鼻窦腺样囊性癌的治疗及预后分析  

Treatment and prognosis analysis of perineural invasion on sinonasal adenoid cystic carcinoma

作　　者：王泽坤 张江鹄 陈雪松 刘清峰 王静波 吴润叶 张烨 王凯 曲媛 黄晓东 肖建平 高黎 徐国镇 易俊林 罗京伟 Wang Zekun;Zhang Jianghu;Chen Xuesong;Liu Qingfeng;Wang Jingbo;Wu Runye;Zhang Ye;Wang Kai;Qu Yuan;Huang Xiaodong;Xiao Jianping;Gao Li;Xu Guozhen;Yi Junlin;Luo Jingwei(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心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：《中华肿瘤杂志》2022年第2期185-191,共7页Chinese Journal of Oncology

基　　金：国家重点研发计划(2016YFC0904600)。

摘　　要：目的分析嗜神经侵袭(PNI)阳性鼻腔副鼻窦腺样囊性癌(ACC)的疗效, 探讨PNI在鼻腔副鼻窦ACC中的预后价值。方法回顾性分析2000年1月至2016年12月中国医学科学院肿瘤医院收治的105例鼻腔副鼻窦ACC患者的临床资料。按照美国癌症联合委员会和国际抗癌联盟第8版分期系统重新分期。随访获取患者治疗失败和生存资料, 预后影响因素的单因素分析采用Log rank检验, 多因素分析采用Cox回归比例风险模型。结果上颌窦(59例)为最常见的肿瘤原发部位, 其次为鼻腔(38例)。Ⅲ~Ⅳ期患者93例。治疗方式包括单纯手术14例, 单纯放疗13例, 术前放疗+手术10例, 手术+术后放疗68例。中位随访91.8个月, 5年局部控制率、无远处转移生存率、无进展生存率和总生存率分别为72.6%、73.0%、52.9%和78.0%。33例(31.4%)患者PNI阳性, 其5年无远处转移生存率、无进展生存率和总生存率分别为53.7%、29.4%和56.5%, 均低于PNI阴性组(分别为80.8%、63.0%和86.8%, 均P<0.05), 而两组的局部控制率差异无统计学意义(64.5%和76.5%, P=0.273)。多因素Cox回归分析显示, PNI阳性为鼻腔副鼻窦ACC患者无远处转移生存(HR=3.514, 95%CI为1.557~7.932)、无进展生存(HR=2.562, 95%CI为1.349~4.866)和总生存(HR=2.605, 95%CI为1.169~5.806)的不良影响因素。在PNI阳性患者中, 手术联合放疗患者的5年局部控制率、无进展生存率和总生存率分别为84.9%、41.3%和72.7%, 均高于单纯手术或放疗患者(分别为23.3%、10.0%和26.7%, 均P<0.05)。结论 PNI的存在增加了鼻腔副鼻窦ACC远处转移的风险。与PNI阴性患者相比, PNI阳性者预后较差。手术联合放疗为主的综合治疗模式治疗PNI阳性鼻腔副鼻窦ACC能取得良好的临床疗效。Objective To analyze the efficacy of sinonasal adenoid cystic carcinoma(ACC)with perineural invasion(PNI),and explore the prognostic value of PNI on sinonasal adenoid cystic carcinoma.Methods The clinical data of 105 patients with sinonasal ACC admitted to Cancer Hospital,Chinese Academy of Medical Sciences from January 2000 to December 2016 were retrospectively reviewed.All patients were restaged according to American Joint Committee on Cancer 8th edition.Follow-up visits were conducted to obtain information of treatment failure and survival outcome.The Log rank test was used for univariate analysis of prognostic factors,and Cox regression model was used for multivariate prognostic analysis.Results The maxillary sinus(n=59)was the most common primary site,followed by the nasal cavity(n=38).There were 93 patients with stageⅢ-Ⅳ.The treatment modalities included surgery alone(n=14),radiotherapy alone(n=13),preoperative radiotherapy plus surgery(n=10),and surgery plus postoperative radiotherapy(n=68).The median follow-up time was 91.8 months,the 5-year local control(LC),distant metastasis-free survival(DMFS),progression-free survival(PFS),and overall survival(OS)rates were 72.6%,73.0%,52.9%and 78.0%,respectively.There were 33 patients(31.4%)with PNI-positive.The 5-year DMFS,PFS,and OS rates of PNI-positive group were 53.7%,29.4%and 56.5%,respectively,which were significantly inferior to those of PNI-negative group(80.8%,63.0%and 86.8%,respectively,P<0.05),while there was no significant difference in the 5-year LC rate between both groups(64.5%vs 76.5%,P=0.273).The multivariate Cox regression analysis showed PNI was one of the poor prognostic factors of DMFS(HR=3.514,95%CI:1.557-7.932),PFS(HR=2.562,95%CI:1.349-4.866)and OS(HR=2.605,95%CI:1.169-5.806).Among patients with PNI-positive,the 5-year LC,PFS and OS rates of patients received surgery combined with radiotherapy were 84.9%,41.3%and 72.7%,respectively,which were significantly higher than 23.3%,10.0%and 26.7%of patients receiving surgery or radiotherapy alone

关 键 词：腺样囊性癌 鼻腔副鼻窦 嗜神经侵袭 治疗 预后 

分 类 号：R739.62[医药卫生—肿瘤]