67例鼻腔鼻窦腺样囊性癌的临床特征及预后分析

The clinical features and prognosis analysis of adenoid cystic carcinoma in nasal cavity and paranasal sinus

目的:回顾性分析鼻腔鼻窦腺样囊性癌(ACC)的临床特征及预后差异。方法:搜集2007-2017年收治的鼻腔鼻窦ACC患者67例,重点分析其病例特征、手术方式,并采用寿命表法、Kaplan-Meir法及Cox比例风险模型分别进行生存及复发结局的生存分析。结果:中位生存时间为6.68年,1年、5年、10年生存率分别为95%、79%、67%。单因素分析显示性别、年龄、首发症状至确诊时间、肿瘤位置、临床分期及Ki-67阳性率与鼻腔鼻窦ACC的预后相关,多因素分析显示性别、首发症状至确诊时间、Ki-67阳性率可作为评价鼻腔鼻窦ACC患者预后的独立危险因素。中位复发时间为6.13年,1年、3年、5年复发率分别为5%、7%、9%。性别、首发症状至确诊时间、切缘情况及Ki-67阳性率与鼻腔鼻窦ACC的复发相关,首发症状至确诊时间、切缘情况、Ki-67阳性率可作为评价鼻腔鼻窦ACC患者复发风险的独立危险因素。结论:性别、首发症状至确诊时间、Ki-67阳性率可作为评价鼻腔鼻窦ACC患者预后的指标。首发症状至确诊时间、切缘情况、Ki-67阳性率可作为评价鼻腔鼻窦ACC患者复发风险的指标。首发症状至确诊时间及Ki-67阳性率能同时指示复发且能同时提示复发及死亡风险,因此针对首发症状至确诊时间长及Ki-67阳性率>30%的患者应缩短复查周期。而手术切缘情况对肿瘤复发风险有指示作用,而对患者远期死亡风险并无明显影响,临床医生应重视各项指示预后的指标,针对较差预后患者,缩短复查时间,改善患者预后。

Objective：To investigate the clinical features and prognosis of adenoid cystic carcinoma（ACC）in nasal cavity and sinus.Method：67 patients with ACC were recruited interview in our department from 2007 to2017.The association between clinical parameters and survival were evaluated by statistical analysis.Result：The1-,5-and 10-overall survival were 95%,79%,67%,and the 1-,3-and 5-year recurrence rate were 5%,7%,9%,respectively.Simple factor analysis displays that age,the location of the tumour,clinical stages,sex,the interval time between starting symptoms to diagnosis time,the expression quantity of Ki-67 were related to the prognosis,and the latter three and surgical margin were also influential factors of distant metastasis after treatment.Multi-factors analysis revealed that sex,the interval time between starting symptoms to diagnosis time,the expression quantity of Ki-67 were significant factors for prognosis,and the latter two and surgical margin were influential factors of distant metastasis after treatment.Conclusion：The sex and the interval time between starting symptoms to diagnosis time and Ki-67 may be independent prognostic factors for ACC.The interval time between starting symptoms to diagnosis time and Ki-67 level may be independent factors of distant metastasis after treatment.Patients with long interval time between starting symptoms to diagnosis time and high expression of Ki-67 may have a higher risk of recurrence and mortality,which need reexamination of cycle-time reduction.The surgical margin is influential factor of distant metastasis,but not for the patientsprognosis.