鼻窦鳞癌预后因素分析

Prognostic factors of squamous cell carcinoma in the paranasal sinus

目的总结鼻窦鳞癌的侵犯范围、临床特点及治疗方法,对预后的影响因素进行分析。方法回顾性分析我院1994至2003年86例鼻窦鳞癌患者临床资料,采用Kaplan-Meier法和Logrank检验对可能的预后影响因素包括性别、年龄、病变部位、病理学分级、T分期、淋巴结转移情况及治疗方法进行分析,并对病变侵犯的不同部位如上颌窦后壁、硬腭、翼腭窝、颞下窝、眶壁、眶内、蝶窦及颅底颅内进行总结并分析其对预后的影响。结果本组患者5年生存率为51.8%,不同病变部位、T分期、淋巴结转移及不同治疗方法患者预后的差异有显著性(P>0.05)。不同病变侵犯部位如中颞下窝、蝶窦、眶壁、眶内容物、蝶窦及颅底颅内受侵对预后影响的差异有显著性意义。结论筛窦鳞癌发病少但预后较差,病变部位、T分期、淋巴结转移、治疗方式是影响患者预后的重要因素;手术加放疗的综合治疗是治疗鼻窦鳞癌的主要治疗方式;颞下窝、蝶窦、眶壁、眶内容物及颅底颅内等部位受侵者预后不良。

Objectives To study the invasive extent, clinical characters and the treatment methods of the patients with squamous cell carcinoma in the paranasal sinus. To analyze the prognostic factors of the patients. Methods The clinical data was analyzed retrospectively in 86 patients with squamous cell carcinoma in the paranasal sinus from 1994 to 2003 in our hospital. The possible prognostic factors including gender, age, location, histological classification, T classification, lymph node metastasis and the treatment method of the patients were analyzed using Kaplan-Meier method and Log-Rank test. The different invasive locations including the posterior wall of the maxillary sinus, hard palate, the pterygomaxillary fossa, infratemporal fossa, the orbital walll, the intraorbital content, the sphenoid sinuses, the skull base and encephalon were studied. Their influences on the prognosis of the patients were also analyzed. Results The overall five-year survival rate was 51.8%. The differences of prognosis between different locations, T stages, lymph node metastasis and the treatment modalities were significant. Local invasive locations associated with poor prognosis included the extension to the infratemporal fossa, the sphenoid sinuses, the orbital wall, the intraorbital content and the invasion to the skull base and encephalon. Conclusions The ethmoidal sinus carcinoma is rare, but has a poor prognosis. The location, T stages, lymph node metastasis and the treatment modality are important factors that affect the prognosis of the patients with squamous cell carcinoma in the paranasal sinus. Combined therapy with surgery and radiotherapy is a better treatment modality than simple radiation. The presence of the invasion to the infratemporal fossa, the sphenoid sinus, the orbital wall, the intraorbital content, the skull base and encephalon indicates a poor prognosis.