局部晚期嗅神经母细胞瘤新辅助化疗25例临床分析

Neoadjuvant chemotherapy in the treatment of locally advanced olfactory neuroblastoma in 25 cases

目的评估局部晚期嗅神经母细胞瘤(olfactory neuroblastoma,ONB)使用新辅助化疗等综合治疗方案的临床效果,并分析新辅助化疗有效性相关临床因素。方法回顾性分析2017年4月至2022年7月于北京同仁医院接受新辅助化疗的ONB患者25例,其中男性16例,女性9例,年龄26~72岁,平均年龄44.9岁。其中Kadish C期22例,D期3例。所有患者经多学科讨论后,采用新辅助化疗-手术-放疗进行治疗,其中17例采用紫杉醇、顺铂和依托泊苷(TEP)方案;4例采用紫杉醇、奈达铂和异环磷酰胺(TPI)方案,3例采用紫杉醇、顺铂/奈达铂(TP)方案,1例采用顺铂和依托泊苷(EP)方案。采用SPSS 25.0软件进行统计学分析,Kaplan-Meier法绘制生存曲线。结果新辅助化疗的整体有效率为32%(8/25)。21例患者采用扩大经鼻内镜肿瘤切除术,4例采用颅鼻联合入路手术。3例D期患者接受了颈部淋巴结清扫术。所有患者均行术后放疗。随访时间6~67个月,全部患者的5年总体生存率和无病生存率分别为100.0%和94.4%。新辅助化疗前Ki-67指数为60%(50%,90%)[M(Q_(1),Q_(3)),后同],化疗后Ki-67指数为20%(3%,30%),化疗前后瘤体组织Ki-67指数变化有统计学意义(Z=-24.24,P<0.05)。分析年龄、性别、手术史、病理分级、新辅助化疗前Ki-67指数以及化疗方案对化疗效果的影响,Ki-67指数≥25%和病理分级高与新辅助化疗有效相关(P值均<0.05)。结论新辅助化疗可以降低ONB患者肿瘤组织Ki-67指数。病理分级和Ki-67指数高是新辅助化疗敏感的相关临床指标。新辅助化疗-手术-放疗的治疗策略,可使局部晚期ONB患者获得满意的5年生存率。

Objective To evaluate the efficacy of neoadjuvant chemotherapy(NACT)in the treatment of locally advanced olfactory neuroblastoma(ONB),and to explore the factors related to the efficacy of NACT.Methods A total of 25 patients with ONB who underwent NACT in Beijing TongRen Hospital from April 2017 to July 2022 were retrospectively analyzed.There were 16 males and 9 females,with an average age of 44.9 years(ranged 26-72 years).There were 22 cases of Kadish stage C and 3 cases of stage D.After multiple disciplinary team(MDT)discussion,all patients were treated sequentially with NACT-surgery-radiotherapy.Among them,17 cases were treated with taxol,cis-platinum and etoposide(TEP),4 cases with taxol,nedaplatin and ifosfamide(TPI),3 cases with TP,while 1 case with EP.SPSS 25.0 software was used for statistical analysis,and survival analyses were calculated based on the Kaplan-Meier method.Results The overall response rate of NACT was 32%(8/25).Subsequently,21 patients underwent extended endoscopic surgery and 4 patients underwent combined cranial-nasal approach.Three patients with stage D disease underwent cervical lymph node dissection.All patients received postoperative radiotherapy.The mean follow-up time was 44.2 months(ranged 6-67 months).The 5-year overall survival rate was 100.0%,and the 5-year disease-free survival rates was 94.4%.Before NACT,Ki-67 index was 60%(50%,90%),while Ki-67 index was 20%(3%,30%)after chemotherapy[M(Q_(1),Q_(3))].The change of Ki-67 before and after NACT was statistically significant(Z=-24.24,P<0.05).The effects of age,gender,history of surgery,Hyams grade,Ki-67 index and chemotherapy regimen to NACT were analyzed.Ki-67 index≥25%and high Hyams grade were related to the efficacy of NACT(all P<0.05).Conclusions NACT could reduce Ki-67 index in ONBs.High Ki-67 index and Hyams grade are clinical indicators sensitive to the efficacy of NACT.NACT-surgery-radiotherapy is effective for patients with locally advanced ONB.