上颌窦癌74例的治疗与影响预后的因素

Treatment and prognostic factors in 74 patients with maxillary sinus carcinoma

目的 :研究上颌窦癌 74例的治疗与影响预后的因素。方法 :1985年 1月— 1995年 12月本院治疗 74例上颌窦癌 ,男、女之比 1.6∶1,中位年龄 5 5岁 (2 5— 76岁 ) ,病理 :鳞癌 5 5例 ,腺癌 8例 ,未分化癌等 11例。T2 4例、T3 32例、T4 38例按AJCC分期 ,确诊时 2 0例有颈部淋巴结转移 ,其中 15例为同侧上颈部。全组原发灶单纯放疗 43例 ,放疗 +手术 31例 ,放疗肿瘤剂量 41天 5 0Gy/ 2 8次— 5 5天 78Gy/ 39次。用Kaplan Meier计算生存率、局控率、转移率 ,用Log Rank进行结果之间的比较 ,用Cox比例风险模型行多因素分析。结果 :全组五年生存率 33.9% ,原发灶五年失控率 5 6 .2 % ,颈部淋巴结五年失败率 2 0 .0 % ,五年远处转移率 19.7%。单纯放疗组、放疗+手术组五年生存率分别为 16 .4%、5 6 .1% (P =0 .0 0 0 3) ,5 4例N0 病例中 7例在治疗中 (后 )出现颈部淋巴结转移 ,5例为同侧上颈部。N(+)组、N(- )组的五年生存率分别为 2 0 %和 41.9% (P =0 .0 0 76 )。结论 :综合治疗有益于上颌窦癌疗效的提高。上颌窦癌治疗失败的原因主要是原发灶 ,而颈部淋巴结转移多在同侧上颈部 。

Purpose:To study treatment and prognostic factors in 74 patients with maxillary sinus carcinoma to improve methods of treatment. Methods:From January 1985 to December 1995,74 patients with maxillary sinus carcinoma were treated in our hospital.There were 46 males and 28 females,with a median age at diagnosis of 55 years(25-76 years),the tumor histology included squamous cell carcinoma ,adenocarcinoma,undifferentiated carcinoma (found in 55,8,11 patients).Using the AJCC method of classication,T 2 4 cases,T 3 32 cases and T 4 38 cases.Twenty of 74 patients had cervical lymphadenopathy at initial presentation,fifteen of 20 patients were in ipsilateral upper neck.Total dose was 50 Gy/28 f/41 d-78 Gy/39 f/55 d.Forty three patients had radiotherapy alone,thirty one had surgical resection and radiotherapy. Kaplan Meier and Log Rank test were used for evaluating the results of the local control and survival rates in this series,the multivariate parameters were analyzed by Cox model. Results:The 5 year survival rates were 33.9% for all patients.The 5 year loss of control rates of primary site were 56.2%,the 5 year neck failurs rates were 20.0%,the 5 year metastatic rates were 19.7%.The 5 year survival rates for radiothery alone, combined therapy were 16.4% and 56.1% respectively( P =0.0003).Of the 54 patients with N 0 disease,7 had neck recurrence,of the 7 neck failure,5 were in ipsilateral upper neck.The 5 year survival rates for patients who remained N 0 were 41.9% and for those [N(+) group] with initial cervical involvement or recurred in the neck were 20%( P =0.0076). Conclusions:Primary local failure is the most cause of therapeutic failure, the neck failure is in ipsilateral upper neck in many patients whose prognosis is poor,combined treatment is beneficial in maxillary sinus carcinoma.