鼻腔鼻窦神经内分泌癌11例诊疗分析

Diagnosis and treatment of 11 cases with sinonasal neuroendocrine carcinoma

目的 探讨鼻腔鼻窦神经内分泌癌的诊疗方法及预后.方法 回顾性分析浙江省肿瘤医院1998-2010年收治的11例鼻腔鼻窦神经内分泌癌患者的临床资料.其中小细胞神经内分泌癌10例,非典型类癌1例.参照Kadish分期本组患者A期2例,B期6例,C期3例.治疗方法采取单纯手术1例,单纯放疗1例,单纯化疗1例,放疗＋化疗2例,以手术为主的综合治疗（手术结合术后放化疗）6例.结果 全部患者随访2个月至12年,综合治疗的6例中1例3年后死亡,1例4年后死亡,1例无瘤生存12年,另2例无瘤生存8年,1例仍在治疗随访中.其他治疗方案的5例中4例1年内死亡,1例1年半后死亡.结论 本病治疗并无统一方案,以手术为主的综合性治疗是较合适的治疗方案.神经内分泌癌易复发,预后较差,早期的准确诊断和综合治疗是提高本病生存率的关键.

Objective To study the diagnosis,treatment and prognosis of sinonasal neuroendocrine carcinoma.Methods The clinical data of 11 cases with sinonasal neuroendocrine carcinoma treated in Zhejiang Cancer Hospital from 1998 to 2010 were analyzed retrospectively.Ten cases were small cell type and one case was atypical carcinoid.Two cases were Kadish stage A,six cases were Kadish stage B and three cases were Kadish stage C.One case was treated by only operation,one case by only radiotherapy,one case by only chemotherapy,two cases by radiotherapy and chemotherapy,and six cases by combined treatment（surgery followed by radiotherapy and chemotherapy）.Results All cases were followed up for 2 months up to 12 years.Of six cases by combined treatment two cases died in 3 years and in 4 years after treatment respectively,three cases survived tumor-free for 12,8 and 8 years and one case was still in treatment.Of other five cases,four cases died in 12 months and one case died in 18 months after treatment.Conclusions There＇s no standard treatment plan.Combined treatment based on surgery should be adopted to nasal neuroendocrine carcinoma.Recurrence is common and the prognosis is poor.The key to improving the survival rate of the disease is early accurate diagnosis and combined treatment.