Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2019, Vol. 33 ›› Issue (5): 87-91.doi: 10.6040/j.issn.1673-3770.0.2018.545

• Original Article • Previous Articles     Next Articles

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

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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

CLC Number: 

  • R739.62

Table 1

Survival of populations with different indicators[n(%)]"

指标 例数 生存 死亡 Fisher/t P
性别 - 0.619
男 8（53.33） 5(62.50) 3(37.50)
女 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)

Table 2

Life time of death and linear regression analysis of 6 indicators"

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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