鼻腔鼻窦癌远处转移的危险因素分析

Associated risk factors for distant metastasis in sinonasal carcinoma

目的探讨与鼻腔鼻窦癌远处转移显著相关的危险因素。方法回顾性分析2003年1月-2013年1月该院耳鼻喉科收治的76例鼻腔鼻窦癌患者的临床病理资料，单因素和多因素回归分析鼻腔鼻窦癌远处转移与临床病理因素的关系。结果鼻腔鼻窦癌远处转移的发生率为15．79％（12／76），其中肺转移占7．89％（6/76），颅内转移占3．95％（3/76），骨转移占2．63％（2/76），肝转移1．31％（1/76）。2例初诊入院时即发现远处转移，其余患者从初诊入院治疗到发现远处转移的时间间隔为4～51个月，间隔中位时间为11个月。鼻腔鼻窦癌远处转移患者的3年和5年累计生存率分别为33．3％和16．7％。对76例鼻腔鼻窦癌进行单因素分析显示病理分化程度（P=0．042）、T分期（P=0．032）以及N分期（P=0．001）均与鼻腔鼻窦癌远处转移有关；多因素回归分析显示N分期与鼻腔鼻窦癌的远处转移显著相关（P=0．042）。结论鼻腔鼻窦癌存在一定比率的远处转移，主要发生在肺转移，其中N分期是影响鼻腔鼻窦癌远处转移的独立危险因素。

Objective To investigate risk factors for distant metastasis in sinonasal carcinoma. Methods Clinicopathological data of 76 patients with sinonasal carcinoma treated at our hospital from January 2003 to January 2013 were retrospectively analyzed. The associa tions between distant metastasis and clinicopathological factors were evaluated by univariate analysis and multivariable logistic regression analysis. Results The overall incidence of distant metastasis in sinonasal carcinoma was 15.79% （12/76）. The target site of distant me tastasis was mainly in lung 7.89% （6/76）, brain 3.95 % （ 3/76）, bone 2.63 % （ 2/76 ）, liver 1.31% （ 1/76 ）. Patients were diagnosed distant metastasis when admitted, and the rest with time interval between 4 and 51 months （ median 11 months ）. The 3-year and 5-year cumulative survivals in sinonasal carcinoma with distant metastasis were 33.3% and 16.7% respectively. Univariate analysis showed that tumor differentiation （ P = 0.042）, T stage （ P = 0. 032）, N stage （ P = 0. 001 ）were associated with distant metastasis. Muhivariable logistic regression analysis showed N stage remained as significant risk factors （P = 0.042）. Conclusions Sinonasal carcinoma has certain per centage of distant metastasis,which is mainly in lung and their prognosis is usually poor. N stage is risk factor for lymph node metastasis in sinonasal carcinoma.