晚期鼻腔鼻窦恶性肿瘤的手术疗效观察  

Oncologic outcomes of surgical treatments of advanced sinonasal malignancies

作　　者：陈梦宇 文译辉[1] 温馨 何蕊 黄子轩 李健[1] 文卫平[1] Chen Mengyu;Wen Yihui;Wen Xin;He Rui;Huang Zixuan;Li Jian;Wen Weiping(Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Sun Yat-sen University,the Institute of Otorhinolaryngology of Sun Yat-sen University,Guangzhou Key Laboratory of Otorhinolaryngology Head and Neck Surgery,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院耳鼻咽喉科医院、中山大学耳鼻咽喉科研究所、广州市耳鼻咽喉头颈外科重点实验室,广州510080

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第5期431-437,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81900918);广东省重点领域研发计划项目(2020B1111190001)。

摘　　要：目的探讨手术治疗晚期鼻腔鼻窦恶性肿瘤(sinonasal malignancies,SNM)的效果。方法回顾性分析2000—2018年中山大学附属第一医院接受手术治疗的229例晚期(T3-4期)SNM患者的临床资料,男性162例,女性67例,年龄(46.8±18.5)岁。167例患者接受单纯内镜手术,30例接受辅助切口内镜手术,32例接受开放手术。采用Kaplan-Meier法估计3年、5年总体生存率及无事件生存率,并进行单因素及多因素Cox回归分析探讨与预后相关的因素。结果患者3年、5年总体生存率分别为69.7%和64.0%,中位总体生存时间为43个月;3年、5年的无事件生存率分别为57.8%和47.4%,中位无事件生存时间为34个月。5年生存率方面,上皮来源的肿瘤较间质来源的肿瘤及恶性黑色素瘤好(72.3%比47.8%比30.0%,χ^(2)=36.01,P<0.001);经病理证实为切缘阴性的患者预后最佳,肉眼切缘阴性其次,最次为肿瘤肉眼可见残留,差异有统计学意义(78.4%比55.1%比37.4%,χ^(2)=24.63,P<0.001);内镜手术组与开放手术组差异无统计学意义(65.8%比53.4%,χ^(2)=2.66,P=0.102)。年龄越大的患者总体生存率(HR=1.02,P=0.011)及无事件生存率更差(HR=1.01,P=0.027),接受辅助治疗的患者死亡风险更低(HR=0.62,P=0.038)。既往有鼻腔放疗史的患者复发风险更高(HR=2.48,P=0.002),死亡风险更高(HR=2.03,P=0.020)。结论对于晚期SNM接受手术治疗的患者,在保证安全切缘的情况下,内镜手术效果可媲美开放手术,可制订以经鼻内镜手术为主综合治疗为辅的治疗方案。Objective To investigate the prognoses of advanced(T3-T4)sinonasal malignancies(SNM).Methods The clinical data of 229 patients with advanced(T3-4)SNM who underwent surgical treatments in the First Affiliated Hospital of Sun Yat-sen University from 2000 to 2018 were retrospectively analyzed,including 162 males and 67 females,aged(46.8±18.5)years old.Among them,167 cases received endoscopic surgery alone,30 cases received assisted incision endoscopic surgery,and 32 cases received open surgery.The Kaplan-Meier method was used to estimate the 3-year and 5-year overall survival(OS)and event-free survival(EFS).Univariate and multivariate Cox regression analyses were performed to explore significant prognostic factors.Results The 3-year and 5-year OS were respectively 69.7%and 64.0%.The median OS time was 43 months.The 3-year and 5-year EFS were respectively 57.8%and 47.4%.The median EFS time was 34 months.The 5-year OS of the patients with epithelial-derived tumors was better than that of the patients with mesenchymal-derived tumors and malignant melanoma(5-year OS was respectively 72.3%,47.8%and 30.0%,χ^(2)=36.01,P<0.001).Patients with microscopically margin-negative resection(R0 resection)had the best prognosis,followed by macroscopically margin-negative resection(R1 resection),and debulking surgery was the worst(5-year OS was respectively 78.4%,55.1%and 37.4%,χ^(2)=24.63,P<0.001).There was no significant difference in 5-year OS between the endoscopic surgery group and the open surgery group(65.8%vs.53.4%,χ^(2)=2.66,P=0.102).Older patients had worse OS(HR=1.02,P=0.011)and EFS(HR=1.01,P=0.027).Patients receiving adjuvant therapy had a lower risk of death(HR=0.62,P=0.038).Patients with a history of nasal radiotherapy had a higher risk of recurrence(HR=2.48,P=0.002)and a higher risk of death(HR=2.03,P=0.020).Conclusion For patients with advanced SNM,the efficacy of endoscopic surgery can be comparable to that of open surgery when presence of safe surgical margins,and a treatment plan based on transnasal endoscopic s

关 键 词：鼻肿瘤 鼻内镜手术 颅底肿瘤 预后 

分 类 号：R739.62[医药卫生—肿瘤]