不同手术方式联合放射治疗KadishB或KadishC期嗅神经母细胞瘤的疗效分析

Therapeutic effects of various surgical procedures combined with radiotherapy Kadish stage B/C esthesioneuroblastoma

目的评估不同手术方式联合放射治疗嗅神经母细胞瘤的疗效。方法回顾分析1979--2014年我院收治的53例接受手术联合放疗的局部晚期嗅神经母细胞瘤疗效，对比不同手术方式肿瘤残存率及治疗效果。组间比较行卡方检验，Kaplan—Me＆r法计算生存率并Logrank法检验。结果全组随访时间中位数为71个月，5年OS、DFS率分别为86％、74％。全组患者按手术方式分为开放手术组31例、内镜手术组22例，内镜手术组肿瘤残存率高于开放手术组（分别为64％、42％，P=0．166）。KadishC期者内镜手术肿瘤残存率达78％。肿瘤完全切除者5年OS、DFS率分别为91％、80％，肿瘤残存者分别为82％、67％。内镜手术组与开放手术组5年OS、DFS率相近[83％与86％（P=0．560）、77％与71％（P=0．188）]。内镜手术组中更多患者接受术后放疗剂量〉66Gy（P=0．011），而术后接受放疗剂量〉66Gy者和≤66Gy者的5年OS、DFS率分别为100％和67％（P=0．092）、100％和50％（P=0．052）。结论手术联合放疗用于改良KadishB、KadishC期嗅神经母细胞瘤可取得较好的治疗疗效。内镜手术应严格掌握指征．目前对KadishC期或额窦受侵者不主张行内镜手术。对手术切缘状态无法保证者，术后放疗剂量建议〉66Gy。

Objective To investigate the therapeutic effects of various surgical procedures combined with radiotherapy in treatment of esthesioneuroblastoma. Methods The clinical data of 53 patients with locally advanced esthesioneuroblastoma who underwent surgery combined with radiotherapy in our hospital were analyzed retrospectively, and the tumor resection rate and therapeutic effect were compared between various surgical procedures. Percentages were compared using the chi-square test. The survival data were estimated using the Kaplan-Meier methods. Results The median follow-up was 70 months, and the 5-year overall survival and disease-free survival were 86% and 74%, respectively. The patients were divided into the open surgery group with 31 patients and the endoscopic surgery group with 22 patients. The endoscopic surgery group had a higher residual tumor rate than the open surgery group （64% vs. 42% ,P=0. 166）, and the patients with Kadish stage C disease in the endoscopic surgery group had a residual tumor rate of 78%. The 5-year overall survival and disease-free survival for patients with a complete tumor resection and those with residual tumor were 91% vs. 80% and 82% vs. 67%, respectively. Although the endoscopic surgery group had a higher residual tumor rate than the open surgery group, the 5-year overall survival and diseasefree survival were 83% vs. 86% （P= 0. 560） and 77% vs. 71% （P= 0. 188）, respectively. The analysis showed that in the endoscopic surgery group, more patients received a dose higher than 66 Gy in the postoperative radiotherapy （P= 0. 011 ）, and the 5-year overall survival and disease-free survival for patients receiving〉66 Gy and ≤66 Gy were 100% vs. 67% （P= 0.092） and 100% vs. 50% （P= 0.052）, respectively. Conclusions Surgery combined with radiotherapy can achieve a good therapeutic effect in patients with modified Kadish stage B/C esthesioneuroblastoma. The indications for endoscopic surgery should be followed strictly, and at present, endoscopic surgery is not suitable for the patients with Kadish stage C esthesioneuroblastoma or with involvement of the frontal sinus. As for the patients with unknown resection margin status, the dose of postoperative radiotherapy should be more than 66 Gy.