头颈部恶性纤维组织细胞瘤临床和预后分析

Clinic and Prognostic Analysis of Malignant Fibrous Histiocytoma in Head and Neck

目的 探讨头颈部恶性纤维组织细胞瘤 (MFH )的临床病理特点、治疗方法 ,分析影响预后的相关因素。方法 回顾性分析 40例头颈部恶性纤维组织细胞瘤的临床资料 ,用Kaplan Meier法进行生存分析 ,对可能影响预后的 12项因素进行单因素和多因素分析 ,组间比较用Log rank检验 ,多因素分析采用Cox模型 ,不同因素间相关关系分析用 χ2 检验。结果 头颈部MFH 5年累积生存率为 42 .0 % ;局部复发率约 3 7.1% ;影响预后的因素主要为 :肿瘤发生部位、治疗方式、颈淋巴结转移、病理分级、肿瘤局部复发 (P <0 .0 1) ;病理分级与肿瘤发生部位相关 ;以手术为主的综合治疗者较单纯手术、放疗和化疗者预后佳 (P <0 .0 5 )。结论 头颈部MFH患者预后差、复发率高 ,颈淋巴结转移、病理分化差、局部复发患者预后差 。

Objective To investigate the clinical pathological features,treatment methods of the Malignant fibrous histiocytoma(MFH) in head and neck and the correlated factors with the prognosis.Methods Forty cases of MFH in head and neck were reviewed retrospectively.Survival analysis was performed by Kaplan-Meier method,and the 12 factors that may affected the tumor prognosis were analyzed using univariate and multivariate analysis.Comparison between groups was performed by Log-rank test and multivariate analysis was carried out by Cox proportional hazard modal.Comparison between the factors was performed by χ 2 test.Results The overall 5-year survival rate(OS) of MFH in head and neck was 42.0% and the local recurrence rate was 37.1%.The significant independent factors rlated to the prognosis were tumor site,treatment method,neck lymph node metastasis,histological grade and local recurrence(P<0.01).Histologic grades was highly dependent on tumor situation.A better survival rate was achieved by surgery-predominant multimodality than by surgery,radiotherapy or chemotherapy singly(P<0.05).Conclusion MFH in head and neck has a poor prognosis and a high local recurrence rate.The patients with neck lymph node metastasis,high histological grade and local recurrence of MFH have a poor prognosis.Surgery-predominant multimodality can improve the local control rate and OS of MFH in head and neck.