上颌窦腺样囊性癌32例临床分析

Analysis of 32 cases with adenoid cystic carcinoma in maxillary sinus

目的总结上颌窦腺样囊性癌的临床特征、治疗方法及治疗效果,评价影响患者预后的因素。方法回顾性分析32例腺样囊性癌患者的临床病理资料,其中Ⅱ期患者4例(T2N0M04例),Ⅲ期17例(T3N0M017例),Ⅳ期11例(T4N0M010例,T4N1M01例)。比较单纯手术、单纯放疗以及手术+放疗三种不同治疗方式的疗效,分析筛状型、管状型、实质型三种不同组织学类型患者的预后,并对治疗和预后进行统计学分析,生存分析采用Kaplan-Meier法,组间比较采用Log-Rank检验,多因素分析采用Cox回归分析。结果经初次治疗后,全组50%的患者(16/32)带瘤生存,全组5年生存率为59.4%,其中Ⅱ期患者为75.0%,Ⅲ期患者为64.7%,Ⅳ期患者为45.5%;单纯手术组、单纯放疗组以及手术+放疗组的5年生存率分别为62.5%、40.0%和80.3%;筛状型、管状型、实质型三种组织学类型患者的5年生存率分别为82.7%、60.0%和37.5%,差异均有统计学意义(P<0.05)。结论上颌窦腺样囊性癌应采取以手术治疗为主、结合放疗的综合性治疗方案。病变分期、组织学类型、治疗方式以及初次治疗后是否有肿瘤残留对预后有较大的影响。

Objective To investigate the clinical features, therapeutic methods and the prognosis of the patients with adenoid cystic carcinoma （ACC） in maxillary sinus. Methods Thirty two ACC patients were reviewed and analyzed to evaluate the resuk of different modalities. Of the 32 cases reviewed and analyzed, 4 were at stage Ⅱ （T2N0M0）, 17 were at stage Ⅲ（T3N0M0）, and 11 were at stage Ⅳ （10 of T4 N0 M0 and 1 of T4 N1 M0 ）. The contribution of every influencing factor on the prognosis was also analyzed. Cumulative survival rate was analyzed by Kaplan-Meier method. The log-rank test was applied to compare survival rates, and multivariate analysis was carried out using Cox proportional hazard model. Results Fifty percent of patients （16/32） survived carrying residual tumor after receiving the first treatment, and the 5-year survival rate for all the patients was 59.4%. The 5-year survival rates for the patients with tumors at stage Ⅱ, stage Ⅲ and stage Ⅳ were 75%, 64. 7% and 45. 5%, respectively. The 5-year survival rate for the patients who received surgery combined with radiotherapy was 80. 3%, that for the patients who received surgical treatment or radiotherapy alone were 62. 5% and 40%, respectively. The 5-year survival rate for the patients who suffered from the ACC of cribriform, tubular form and parenchymatous form was 82. 7 %, 60% and 37.5%, respectively （P〈0. 05）. Conclusions Advanced ACC in maxillary sinus should be treated by surgery and radiotherapy in combination. Malignant stage, therapeutic methods, pathological types and short-term therapeutic response of treatment are the most important factors affecting the prognosis of the patients with ACC in maxillary sinus.