鼻咽原发性腺癌23例临床病理分析

Clinical analysis of twenty-three nasopharyngeal adenocarcinoma patients

目的:探讨鼻咽原发性腺癌的发病情况、临床规律及临床诊治、预后情况。方法:回顾性分析1995-05-2008-10在我院经过病理确诊和治疗的23例鼻咽腺癌的临床资料。普通型腺癌12例,涎腺型腺癌11例。17例单纯放疗,1例单纯手术治疗,3例术后辅助放疗,1例术后残留补救放疗,1例术前放疗。随访4～204个月(中位随访时间55个月),随访率100%,生存期计算自病理确诊日开始至死亡或随访截止日。利用SPSS16.0软件包进行统计学分析,局控率、生存率分析采用Kap-lan-Meier法计算,颈淋巴结转移相关因素分析采用四格表的确切概率法。结果:本组病例占我院同期鼻咽癌病例总数的0.37%。发病年龄32～62岁,男女比例2.3∶1。颈部淋巴结转移率35%。5和10年局控率分别为64.8%和15.2%;5和10年生存率分别为78.2%和29.3%,病理类型、分化程度与淋巴结转移密切相关,差异具有统计学意义。结论:鼻咽腺癌临床表现与鼻咽癌类似,淋巴结转移主要与病理类型、分化程度有关;涎腺型、低度恶性普通型腺癌淋巴结转移少见,而高度恶性普通型腺癌淋巴结转移率高。虽放疗为主治疗可以取得较好生存率,治疗上应进一步探讨根据具体病理类型采取以手术为主或放疗为主的综合治疗。

OBJECTIVE：To analyze the prevelance,treatment and prognosis of nasopharyngeal adenocarcinoma patients.METHODS The data of 23 nasopharyngeal adenocarcinoma patients from May.1995 to Sep.2008 were retrospectively analyzed.There were 12 surface origin type and 11 salivary gland type.There were 17 patients treated with radiation therapy alone,1 with surgery alone,3 with surgery and postoperative adjuvant radiation therapy,1 with surgery and postoperative salvage radiation,1 with preoperative radiation therapy and surgery.Median interal time were 55 months（range 4-204 months）.Overall survival（OAS）and local failure-free survival（LFFS）rates were calculated by Kaplan-Meier method,Analysis of cervical lymph node metastasis related factors using a four-frame table exact test.RESULTS：The 23 patients with nasopharyngeal adenocarcinoma accounted for only 0.37% of all nasopharyngeal cancer patients diagnosed simultaneously in our hospital.Age of getting disease was 32 to 62 years old with male to female ratio of 2.3∶1.Cervical lymphatic metastasis rate is 35%.The 5-and 10-year LFFS were 64.8%,15.2%,respectively.The corresponding OAS were 78.2%,29.3%,respectively.Pathological type and differentiation degree were significant factors for cervical lymph node metastasis.CONCLUSION：Clinical performance of nasopharyngeal adenocarcinoma is similar to nasopharyngeal carcinoma.The lymph node metastasis is dependent on pathological type and differentiation degree,which is rare in salivary gland type and low-grade adenocarcinoma of surface origin type,but that is high in high-grade adenocarcinoma of surface origin type.Although the radiotherapy predominnant had achieved better survival rates,treatment should be further explored combined surgery and radiation therapy or chemoradiotherapy by pathological type.