鼻腔腺样囊性癌的临床研究

Clinical study on adenoid cystic carcinoma in the nasal cavity

目的 探讨影响鼻腔腺样囊性癌患者预后的因素。方法 原发于鼻腔的腺样囊性癌38例 ,对其治疗与预后进行统计分析。生存分析采用Kaplan Meier法 ,组间比较采用Logrank检验 ,多因素分析采用Cox比例风险模型。结果 临床治疗结束时肿瘤完全消失者 5、10年生存率分别为10 0 %和 88.9% ,临床治疗结束时残留者 5、10年生存率分别为 4 8.0 %和 0 % (P <0 .0 1)。早期 (Ⅰ、Ⅱ期 )患者 5、10年生存率分别为 86 .7%和 75 .8% ,晚期 (Ⅲ、Ⅳ期 )患者分别为 5 8. 6 %和 0 % (P <0 .0 1)。单纯手术者 5、10年生存率分别为 5 1.4 %和 2 5 .7% ,单纯放射治疗者均为 5 0 .0 % ,综合治疗者分别为 84 .4 %和 6 2 .0 % (P >0 .0 5 )。多因素分析表明临床治疗近期疗效、临床分期是影响预后的独立因素。结论 鼻腔腺样囊性癌的治疗以综合治疗为主 ,临床治疗近期疗效、临床分期和临床治疗方法对预后有重要影响。

Objective To identify pertinent prognostic variables related to adenoid cystic carcinoma (ACC) in the nasal cavity. Methods A statistic analysis of the clinical results and prognosticators was performed on 38 cases with primary ACC in the nasal cavity. Kaplan-Meier method was used for survival analysis and Log-rank test in comparison, Cox proportional hazard model in multivariate analysis. Results The 5-, 10- year survival rates were 100% and 88.9% in patients whose lesions disappeared completely after their treatment,whereas 48.0% and 0% in patients with lesion which remained (P< 0.01). The 5-, 10- year survival rates were 86.7% and 75.8% in patients with Stage Ⅰ-Ⅱ ACC, while they were only 58.6% and 0% in Stage Ⅲ-Ⅳ lesions(P<0.01). The 5-, 10- year survival rates of 51.4% and 25.7% were obtained in patients who received surgical operation, 50.0% and 50.0% in those treated by with radiotherapy. Besides,they were 84.4% and 62.0% by combined therapy (P>0.05). Multivariate analysis revealed that the therapeutic response and clinical stage were independent factors of prognosis. Conclusions We recommend combined therapy for ACC in the nasal cavity. And clinical stage, treatment approach and short-term therapeutic response are identified as ACC predictors.