内镜经鼻手术治疗鼻颅底腺样囊性癌的疗效分析  

Analysis of the efficacy of endoscopic transnasal surgery for sinonasal and skull base adenoid cystic carcinoma

作　　者：危维[1] 刘俊其[1] 齐岩[1] 李晓敏 孟繁玥 任沁展 严波[1] 王振霖[1] 张秋航[1] Wei Wei;Liu Junqi;Qi Yan;Li Xiaomin;Meng Fanyue;Ren Qinzhan;Yan Bo;Wang Zhenlin;Zhang Qiuhang(Department of Otorhinolaryngology Head and Neck Surgery,XuanWu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院耳鼻咽喉头颈外科,北京100053

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第5期438-444,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨内镜经鼻手术在鼻颅底腺样囊性癌治疗中的作用,并分析影响其预后的因素。方法回顾性分析2007年6月至2021年6月首都医科大学宣武医院收治的82例鼻颅底腺样囊性癌患者的临床资料,其中女性43例、男性39例,中位年龄49岁。按照美国癌症联合委员会(AJCC)第8版标准进行TNM分期,用Kaplan-Meier法计算疾病总体生存率和无病生存率,用Cox回归模型进行预后结果的多因素分析。结果82例患者中,临床分期Ⅱ期4例,Ⅲ期14例,Ⅳ期64例;单纯内镜手术42例,内镜手术+放疗32例,内镜手术+放化疗8例。随访8~177个月,5年总体生存率和无病生存率分别为63.0%和51.6%,10年总体生存率和无病生存率分别为51.2%和31.8%。T分期高、颈内动脉受累是影响患者预后的独立危险因素(P值均<0.05),内镜手术或内镜手术+放疗的总体生存率高于内镜手术+放化疗(P值均<0.05)。结论内镜经鼻手术或联合放疗是治疗鼻颅底腺样囊性癌的有效方式,T分期高、颈内动脉受累的患者预后较差。Objective To evaluate the efficacy of endoscopic transnasal surgery for sinonasal and skull base adenoid cystic carcinoma(ACC),and to analyze the prognostic factors.Methods Data of 82 patients(43 females and 39 males,at a median age of 49 years old)with sinonasal and skull base ACC who were admitted to XuanWu Hospital,Capital Medical University between June 2007 and June 2021 were analyzed retrospectively.The patients were staged according to American Joint Committee on Cancer(AJCC)8th edition.The disease overall survival(OS)and disease-free survival(DFS)rates were calculated by Kaplan-Meier analysis.Cox regression model was used for multivariate prognostic analysis.Results There were 4 patients with stageⅡ,14 patients with stageⅢ,and 64 patients with stageⅣ.The treatment strategies included purely endoscopic surgery(n=42),endoscopic surgery plus radiotherapy(n=32)and endoscopic surgery plus radiochemotherapy(n=8).Followed up for 8 to 177 months,the 5-year OS and DFS rates was 63.0%and 51.6%,respectively.The 10-year OS and DFS rates was 51.2%and 31.8%,respectively.The multivariate Cox regression analysis showed that late T stage and internal carotid artery(ICA)involvement were the independent prognostic factors for survival in sinonasal and skull base ACC(all P<0.05).The OS of patients who received surgery or surgery plus radiotherapy was significantly higher than that of patients who received surgery plus radiochemotherapy(all P<0.05).Conclusions Endoscopic transonasal surgery or combing with radiotherapy is an effective procedure for the treatment of sinonasal and skull base ACC.Late T stage and ICA involvement indicate poor prognosis.

关 键 词：癌 腺样囊性 内窥镜检查 鼻外科手术 预后 

分 类 号：R739.62[医药卫生—肿瘤]