53例嗅神经母细胞瘤的临床分析

Clinical analysis of 53 cases of esthesioneuroblastoma

背景与目的:嗅神经母细胞瘤患者预后不良,如何提高治疗效果、延长患者的生存期是临床研究中亟需解决的问题。本研究探讨影响嗅神经母细胞瘤预后的因素及合理的治疗方法。方法:回顾性分析1980～2003年间我院收治的53例嗅神经母细胞瘤患者的临床资料,采用Kaplan-Meier法分析嗅神经母细胞瘤的临床特征、治疗方式与预后的关系,并比较不同治疗方式的疗效。结果:本组患者总5年生存率为41%。单纯手术组、单纯放疗组、单纯化疗组、手术联合放化疗组和放疗联合化疗组患者的5年生存率分别为42%、38%、0%、56%、0%,采用不同治疗方式患者的生存率比较差异有统计学意义(P<0.05)。Kadish临床分期A期、B期、C期5年生存率分别为100%、37%、31%,不同临床分期患者生存率比较差异有统计学意义(P<0.05)。复发率51%,复发组、无复发组5年生存率分别为42%、48%。结论:嗅神经母细胞瘤复发率高,以手术为主的综合治疗方案是较优的治疗模式。预后与临床分期、治疗方式有关。

Background and Objective： The prognosis of esthesioneuro- blastoma （ENB） patients is poor. This study was to analyze prognostic factors and explore a rational treatment for ENB. Methods： Clinical data of 53 ENB patients, treated at Sun Yat-sen University Cancer Center from 1980 to 2003, were analyzed retrospectively. The correlation of prognostic factors to clinical features and treatment approaches were analyzed using the Kaplan-Meier method. Efficacy of different treatment modalities was compared. Results： The 5-year overall survival （OS） was 41% of all ENB patients. The 5-year OS of the surgery group, radiotherapy group, chemotherapy group, surgery combined with radiotherapy and （or） chemotherapy group, chemoradiotherapy were 42%, 38%, 0, 56%, 0, respectively, which were statistically significant （P〈 0.05）. The 5-year OS of Kadish stage A, B, C patients were 100%, 37%, 31%, respectively, which were statistically significant among these three subgroups which （P〈0.05）. The recurrence rate over the entire period was 51%. The 5-year OS of the recurrence group and recurrence-free group were 42% and 48%, respectively, without significant differences （P〉0.05）. Conclusions： ENB is a malignant tumor with high rates of Iocoregional recurrence and distant metastasis. Surgery-based multimodality is a relatively reasonable method. The prognosis of ENB is associated with the clinical stage and treatment modalities.