副鼻窦恶性肿瘤术后放化疗的临床观察

Clinical Observation of Postoperative Chemoradiotherapy for Nasal Cavity Paranasal Sinus Malignant Tumor

目的探讨鼻腔副鼻窦恶性肿瘤术后放化疗的临床效果。方法选取105例鼻腔副鼻窦恶性肿瘤术后放化疗患者,采用Kaplan-Meler法计算患者的生存率,采用Log-rank法进行生存率差异性检验。结果 105例患者放疗结束后,CR 42例,PR 14例,有效率为53.33%(56/105);化疗结束后,CR 55例,PR 23例,有效率74.29%(78/105)。放化疗近期疗效明显优于放疗,差异具有统计学意义(P<0.05)。患者1年生存率明显高于3、5、10年生存率(P<0.05),其中3、5、10年生存率腺癌亦显著高于鳞癌(P<0.05)。单因素分析发现临床分期、病理类型和手术方法是放化疗疗效的影响因素,其中Ⅱ期中位生存时间明显高于Ⅲ~Ⅳ期、腺癌高于鳞癌、微创切除高于广泛性切除,比较差异均有统计学意义(P<0.05);经Cox模型多因素分析发现临床分期、病理类型和手术方法是影响放化疗疗效和预后的独立影响因素。全部患者未出现严重近期并发症,随访发现听视力障碍11例。结论术后放化疗是改善鼻腔副鼻窦恶性肿瘤临床效果的重要环节,临床分期、病理类型是影响术后放化疗疗效的主要影响因素。

Objective To study the clinical effects of postoperative chemoradiotherapy for nasal cavity paranasal sinus malignant tumor. Methods The survival rates of 105 nasal cavity paranasal sinus malignant tumor patients treated with postoperative chemoradiotherapy were calculated by the Kaplan-Meler method,the survival rate difference test was conducted by Log-rank.Results After radiotherapy,CR was 42 cases,PR was 14 cases,effective rate was 53. 33%( 56 /105),after chemotherapy,CR was 55 cases,PR was 23 cases,effective rate was 74. 29%( 78 /105),short-term curative effect of chemoradiotherapy was superior to radiation therapy( P < 0. 05). 1-year survival rate was significantly higher than 3-,5-,10-year survival rates( P < 0. 05),in which 3-,5-,10-year survival rates of adenocarcinom were significantly higher than those of squamous cancer( P < 0. 05). Single factor analysis showed that clinical stage,pathological type and surgical method were the influence factors for curative effects of chemoradiotherapy,median survival time of stageⅡ was significantly longer than that of stage Ⅲ ~ Ⅳ,median survival time of adenocarcinom was significantly longer than that of squamous cell carcinomas,minimally invasive resection was higher than extensive resection( all P < 0. 05),the Cox model multi-factor analysis showed that clinical stage,pathological type and operative method were independent factors for curative effects and prognosis of chemoradiotherapy. All patients had no severe complications,recent follow-up showed that listening & visual impairment in 11 cases. Conclusion Postoperative chemoradiotherapy can improve clinical effects of the nasal cavity paranasal sinus malignant tumor,and clinical stage and pathological types are the main factors influencing efficacy of postoperative chemoradiotherapy.