46例鼻咽腺样囊性癌治疗模式探讨及预后分析

Treatment modalities and clinical prognosis of 46 patients with nasopharyngeal adenoid cystic carcinoma

目的探讨分析原发鼻咽腺样囊性癌的临床治疗模式及预后。方法回顾分析1971-2015年中国医学科学院肿瘤医院收治的46例原发鼻咽腺样囊性癌患者,男22例、女24例,中位年龄47岁(23~74岁)。其中34例患者接受单纯放疗,应用常规放疗技术25例,调强技术9例,5例患者因放疗后肿瘤残存行挽救性手术;12例接受综合治疗(手术+术后放疗)。结果中位随访时间66.0个月(11.0~270.6个月),5、10年总生存率分别为70%、40%,局部控制率分别为64%、47%,无远处转移率分别为70%、62%。单纯放疗组放疗结束疗效评价达完全缓解者12例,部分缓解者13例,无变化者9例。单纯放疗、术后放疗5年总生存率分别为69%、74%,5年局部控制率分别为63%、66%(P均>0.05)。结论鼻咽腺样囊性癌病程发展相对缓慢,放疗敏感者首选放疗,放疗不敏感者或放疗后残存者可行挽救性手术。

Objective To analyze the clinical treatment modalities and clinical prognosis of patients diagnosed with primary nasopharyngeal adenoid cystic carcinoma (NACC). Methods The medical records of 46 patients with NACC between March 1971 and November 2015 were retrospectively analyzed. Among them, 22 patients were male and 24 female. The median age of all patients was 47 years (range: 23-74 years). Among them, 34 patients received radiotherapy alone including 25 patients treated with conventional radiotherapy and 9 receiving intensity-modulated radiation therapy (IMRT). Five patients underwent salvage surgery for the residual tumors after radiotherapy. Twelve patients were treated with a comprehensive treatment modality (surgery combined with radiotherapy). Results The median follow-up time was 66.0 months (range: 11.0-270.6 months). The 5-and 10-year overall survival, locoregional failure-free survival, and distant metastasis failure-free survival rates were 70% and 40%, 64% and 47%, 70% and 62%, respectively. In the radiotherapy alone group, 12(35%) cases obtained complete response, 13 had partial response and 9 remained stable after radiotherapy. The 5-year overall survival and locoregional failure-free survival rates in the radiotherapy alone and combined therapy groups were 69% and 74%, 63% and 66%, respectively (all P>0.05). Conclusion The course of NACC is relatively slow. Radiotherapy is recommended for patients with high sensitivity towards radiotherapy. Salvage surgery is feasible for those who are insensitive to radiotherapy or with residual tumor after radiotherapy.