成人嗅神经母细胞瘤20例综合治疗结果分析

Clinical analysis of 20 adults esthesioneuroblastoma with combined therapy

目的回顾性分析与比较20例经综合治疗的嗅神经母细胞瘤患者的生存差异，探讨最佳治疗策略。方法1998年1月至2005年1月中山大学肿瘤防治中心采用综合疗法治疗了≥14岁的嗅神经母细胞瘤患者20例，6例为KadishB期，14例为KadishC期。12例采用诱导化疗联合放疗，8例为手术联合放疗。以Kaplan—Meier法统计患者的生存率和无瘤生存率，采用Log—rank法比较两种治疗方法的生存率差异，Fisher精确概率法检验其组间均衡性。结果自治疗开始之日随访至2008年3月31日，20例综合治疗患者3年生存率50．0％。诱导化疗联合放疗组12例的3年生存率和3年无瘤生存率分别为25．0％和16．7％；手术联合放疗组8例的3年生存率和3年无瘤生存率分别为87．5％和75．0％。手术联合放疗组的生存率和无瘤生存率均优于诱导化疗联合放疗组（x^2值分别为6．81和7．33，P值分别为0．0091和0．0068）。结论对于中晚期成人嗅神经母细胞瘤，手术联合放疗的疗效可能优于诱导化疗联合放疗，积极手术联合放疗及化疗的综合治疗策略有望进一步改善其生存率。

Objective To retrospectively compare the survival difference of 20 patients with esthesioneuroblastoma （EN） who received combined therapy, and try to analysis the most optimized modalities. Methods Twenty patients of adult （ ≥ 14 years ） EN recieved combined therapy in Cancer Center of Sun Yat-sen University from Jan 1998 to Jan 2005. Six patients were staged Kadish B and fourteen patients Kadish C. Twelve of them received induction chemotherapy followed by radiotherapy while the other 8 received surgery followed by adjuvant radiotherapy. The disease free survival and overall survival rate were calculated by Kaplan-Meier method and compared by Log-rank method. And the baseline characteristics was examined by Fisher＇s exact test. Results Follow up from beginning of treatment to 31th March ,2008, the 3-year overall survival rate was 50. 0%, the 3-year disease free survival and overall survival rates were 16. 7%, 25.0% for chemora-diation group and 75.0%, 87.5% for surgery plus radiotherapy group, respectively. The disease free survival and overall survival rate of the latter group were better than the former （ x^2 values were 6. 81 and 7. 33,P values were 0. 0091 and 0. 0068, respectively）. Conclusions Surgery combined with adjuvant radiotherapy may increase the survival rate compared with induction chemotherapy followed by radiotherapy for local advanced esthesioneuroblastoma. Active surgery combined with radiotherapy and chemotherapy may further improve the survival of EN.