山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (5): 87-91.doi: 10.6040/j.issn.1673-3770.0.2018.545

• 论著 • 上一篇    下一篇

鼻腔鼻窦腺样囊性癌15例临床分析

冯剑,周涵,宋圣花,赵青,张佳程,刘雅琴,沈宇杰,董伟达()   

  1. 南京医科大学第一附属医院 江苏省人民医院耳鼻咽喉科,江苏 南京 210029
  • 收稿日期:2018-11-24 修回日期:2019-04-15 出版日期:2019-09-20 发布日期:2019-10-15
  • 通讯作者: 董伟达 E-mail:weidadong2649@126.com
  • 基金资助:
    江苏省卫生计生委面上课题(H201603);江苏省青年医学人才项目(QNRC2016614)

Clinical analysis of 15 cases of adenoid cystic carcinoma in the paranasal sinuses and nasal cavity

Jian FENG,Han ZHOU,Shenghua SONG,Qing ZHAO,Jiacheng ZHANG,Yaqin LIU,Yujie SHEN,Weida DONG()   

  1. Department of Otolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nangjing 210029, Jiangsu, China
  • Received:2018-11-24 Revised:2019-04-15 Online:2019-09-20 Published:2019-10-15
  • Contact: Weida DONG E-mail:weidadong2649@126.com

摘要: 目的

探讨鼻腔鼻窦腺样囊性癌的临床特点、诊断、治疗方式及预后。

方法

回顾性分析2008年1至10月南京医科大学第一附属医院收治的15例经病理证实为鼻腔鼻窦腺样囊性癌患者的临床资料,并对该病预后相关因素进行统计学分析。

结果

15例患者首诊症状:鼻塞5例(33%),鼻出血5例(33%),眼胀痛、溢泪3例(20%),局部隆起3例(20%),面部麻木2例(13%),头痛1例(7%),无症状1例(7%)。15例患者均行手术切除,其中4例行鼻内镜手术治疗(26.7%),9例行鼻侧切手术+术后放疗(60%),2例行鼻侧切手术+术后放化疗(13.3%)。术后病理学检查结果显示,高分化(管状型、筛状型)10例(66.7%),低分化(实体型)5例(33.3%)。15例患者均获随访,随访时间6个月~10年。截至2018年10月,15例患者存活8例(53%),死亡7例(47%);早期患者(Ⅰ、Ⅱ期)4例,死亡1例,晚期患者(Ⅲ、Ⅳ期)11例,死亡6例;总体1年、3年、5年、10年生存率分别为93%、87%、73%、53%。手术模式与生存年限间呈正相关(t=4.406 P=0.003);年龄、分化程度与生存年限间呈负相关(t分别为-2.390、-6.126, P分别为0.048、<0.001);性别、手术方式、临床分期与生存年限无相关性(P分别为0.154、0.262、0.052)。

结论

鼻腔鼻窦腺样囊性癌临床表现多样且无特异性,早期诊断困难。外科手术是治疗鼻腔鼻窦腺样囊性癌的主要治疗手段,鼻内镜手术或鼻内镜辅助开放手术有较好的临床效果。高龄、分化程度与预后相关,对于低分化及晚期肿瘤患者应采取综合治疗模式,并缩短定期复查时间,终身随访。

关键词: 鼻腔鼻窦, 腺样囊性癌, 预后因素分析

Abstract: Objective

To explore the clinical features, diagnosis, treatment, and prognosis of adenoid cystic carcinoma of the nasal cavity and paranasal sinuses.

Method

We performed a retrospective analysis of the clinical data of 15 patients with adenoid cystic carcinoma of the nasal cavity and paranasal sinuses admitted to the First Affiliated Hospital of Nanjing Medical University in the period from January to October 2008. The prognostic factors of the disease were statistically analyzed.

Result

The initial diagnoses in the 15 patients included: nasal congestion in 5 cases (33%), nose bleeding in 5 cases (33%), eye pain and tearing in 3 cases (20%), local uplift in 3 cases (20%), facial numbness in 2 cases (13%), headache in 1 case (7%), and 1 case (7%) without symptoms. All 15 patients underwent surgical resection; 4 underwent endoscopic sinus surgery (26.7%), 9 underwent nasal resection and postoperative radiotherapy (60%), and 2 underwent nasal excision and postoperative radiochemotherapy (13.3%). Postoperative pathological examination revealed highly differentiated (tubular type, sieve type) adenoid cystic carcinoma in 10 cases (66.7%) and poorly differentiated (solid type) in 5 cases (33.3%). All 15 patients were followed up for a period of 6 months to 10 years. As of October 2018, 8 of the 15 patients survived (53%), and 7 had died (47%). Of the 4 patients at an early stage of the disease (I and II), one died, and among the 11 patients that were in the advanced stage of the disease (III, IV), there were 6 deaths. The overall 1-, 3-, 5-, and 10-year survival rates were 93%, 87%, 73%, and 53%, respectively. There was a positive correlation between the surgical mode and the life span (t=4.406, P=0.003), and a negative correlation between age, differentiation, and life span (t= -2.390, -6.126 P=0.048, <0.001, respectively). Gender, surgical procedure, clinical stage, and life span were not correlated (P=0.154, P=0.262, P=0.052, respectively).

Conclusion

The clinical manifestations of adenoid cystic carcinoma of the nasal cavity and paranasal sinuses are diverse and non-specific, and early diagnosis is difficult. Surgery is the main treatment for this type of carcinoma. Endoscopic surgery or endoscopic-assisted open surgery has good clinical application value. The age and degree of pathological differentiation are related to the prognosis. For patients with poorly differentiated and advanced tumors, comprehensive treatment mode should be adopted, and regular follow-up time should be shortened for increasing the lifespan.

Key words: Nasal sinus, Adenoid cystic carcinoma, Prognostic factor analysis

中图分类号: 

  • R739.62

表1

不同指标人群生存情况[例(%)]"

指标 例数 生存 死亡 Fisher/t P
性别 - 0.619
8(53.33) 5(62.50) 3(37.50)
7(46.67) 3(42.86) 4(57.14)
年龄(岁, x ˉ ± s ? 52.73±12.49 48.25±10.22 57.86±13.58 -1.561 0.143
<60 11(73.33) 8(72.73) 3(27.27) 0.026
≥60 4(26.67) 0(0.00) 4(100.00)
治疗模式 0.434 >0.999
手术 4(26.67) 2(50.00) 2(50.00)
手术联合放疗 9(60.00) 5(55.56) 4(44.44)
手术联合放化疗 2(13.33) 1(50.00) 1(50.00)
临床分期 - 0.569
Ⅰ~Ⅱ 4(26.67) 3(75.00) 1(25.00)
Ⅲ~Ⅳ 11(73.33) 5(45.45) 6(54.55)
手术方式 - 0.077
鼻侧切 11(73.33) 4(36.36) 7(63.64)
鼻内镜 4(26.67) 4(100.00) 0(0.00)
分化程度 - 0.007
高分化 10(66.67) 8(80.00) 2(20.00)
低分化 5(33.33) 0(0.00) 5(100.00)

表2

生存时间与6个指标线性回归分析"

指标 B SE t CI P
(常量) 3.710 0.560 6.628 2.387 ~5.034 0.000
性别 0.351 0.219 1.599 -0.168 ~0.870 0.154
年龄 -0.662 0.277 -2.390 -1.317 ~-0.007 0.048
手术方式 -0.357 0.292 -1.221 -1.047 ~0.334 0.262
临床分期 -0.797 0.341 -2.340 -1.603 ~0.008 0.052
手术模式 1.039 0.236 4.406 0.481 ~1.597 0.003
分化程度 -1.900 0.310 -6.126 -2.633 ~-1.166 0.000
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