151例上颌窦恶性肿瘤的预后因素分析

Prognostic Analysis of 151 Patients with Maxillary Sinus Malignant Neoplasms

背景与目的:上颌窦恶性肿瘤患者的5年生存率较低,影响其预后的因素尚未研究清楚,有关这方面的研究报道不多,本研究旨在探讨影响上颌窦恶性肿瘤预后的临床病理因素。方法:回顾性分析1983年9月～1999年3月中山大学肿瘤防治中心收治的151例初治上颌窦恶性肿瘤病例,包括鳞癌72例,腺癌44例,肉瘤16例,其它病理类型19例;按UICC1997年分期:Ⅱ期7例,Ⅲ期55例,Ⅳ期89例;手术联合放疗66例,单纯手术14例,单纯放疗25例,其它治疗方式者39例,7例放弃治疗。本研究所有病例均随访5年以上。统计用SPSS10.0软件包完成,用Kaplan-Meier法分析临床、病理参数等各单因素对上颌窦恶性肿瘤预后的影响;用Cox模型进行多因素分析。结果:(1)年龄≤40岁和年龄>40岁的5年累积生存率分别为55.7%和33.3%(P=0.030)。(2)鳞癌、腺癌、肉瘤及其它类型患者的5年累积生存率分别为30.2%、57.5%、24.3%和50.7%(P=0.011)。(3)Ⅱ、Ⅲ、Ⅳ期患者的5年累积生存率分别为85.7%、45.8%和32.7%(P=0.029)。(4)有无淋巴结转移患者的5年累积生存率分别为14.4%和44.1%(P=0.005)。(5)有无远处转移患者的5年累积生存率分别为14.3%和41.1%(P=0.011)。(6)未治、单纯手术、单纯放疗、手术联合放疗和其它治疗方式的5年累积生存率分别为14.3%、42.9%、32.3%、50.

BACKGROUND &OBJECTIVE: Five-year survival rate of patients with m axillary malignant neoplasms is low, the prognostic factors of these neoplasms w ere unclear. This study was to investigate prognostic factors of maxillary sinus malignant neoplasms. METHODS: Records of 151 inpatients with malignant neoplasm s of maxillary sinus initially treated at Cancer Center of Sun Yat-sen Universi ty from Sep. 1983 to Mar. 1999 were reviewed. Of 151 cases, 72 were squamous cel l carcinoma (SCC), 44 were adenocarcinoma, 16 were sarcoma, and 19 were other hi stological types; according to 1997 UICC classification, 7 were stage Ⅱ, 55 wer e stage Ⅲ, and 89 were stage Ⅳ; 66 patients received combined therapy of surge ry and radiotherapy, 14 received surgery alone, 25 received radiotherapy alone, 39 received other treatments, and 7 gave up treatment. All patients were followe d up for more than 5 years. Influences of clinicopathologic factors on prognosis of patients with maxillary sinus malignant neoplasms were analyzed by Kaplan-M eier method, and Cox regression model with SPSS10.0 software. RESULTS: Five-yea r overall survival rate of patients of ≤40 years old was 55.7%, that of patien ts of >40 years old was 33.3%(P=0.030); that of patients with SCC was 30.2%, o f patients with adenocarcinoma was 57.5%, of patients with sarcoma was 24.3%, of patients with tumor of other histological types was 50.7%(P=0.011); that of patients with tumor of stage Ⅱ, Ⅲ, and Ⅳwere 85.7%, 45.8%, and 32.7%, resp ectively (P=0.029); that of patients with cervical metastases was 14.4%, of pat ients without cervical metastases was 44.1%(P=0.005); that of patients with dis tant metastases was 14.3%, of patients without distant metastases was 41.1%(P= 0.011); that of patients without treatment was 14.3%, of patients treated with surgery alone was 42.9%, of patients treated with radiotherapy alone was 32.3% , of patients treated with combined therapy of surgery and radiotherapy was 50.8 %, of patients treated with other treatments was 29.1%(P=0.004). Univariate su rvival analysis showed that the above 6 factors were prognostic factors of patie nts with maxillary sinus malignant neoplasms. Multivariate analysis showed that combination of surgery and radiotherapy (P=0.004, OR< 1), clinical stage (P=0.02 5, OR >1), SCC (P=0.016, OR >1), and sarcoma (P=0.003, OR >1) were independent p rognostic factors of patients with maxillary sinus malignant neoplasms. CONCLUSI ON: For maxillary sinus malignant neoplasms, patients with SCC or sarcoma had po orer survival than patients with adenocarcinoma or other histological types of t umor; patients with sarcoma had poorer survival than patients with SCC. The high er the patients clinical stage was, the worse his prognosis was. Combination o f surgery and radiotherapy may be the best treatment for patients with maxillary sinus malignant neoplasms.