Guo Gui-Fang, Yang An-Kui, Xie Ru-Hua, Chen Zhi-Hua, Wu Qiu-Liang, Ou Shen-Ming, Liu Wei-Wei, Xia Liang-Ping, Chen Ming-Yuan, Zhang Jin-Xin, Wu Jian-Hui
Department of VIP Inpatient Service Section Three, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P.R.China.
Ai Zheng. 2004 Nov;23(11 Suppl):1546-50.
BACKGROUND & OBJECTIVE: Five-year survival rate of patients with maxillary malignant neoplasms is low, the prognostic factors of these neoplasms were unclear. This study was to investigate prognostic factors of maxillary sinus malignant neoplasms.
Records of 151 inpatients with malignant neoplasms of maxillary sinus initially treated at Cancer Center of Sun Yat-sen University from Sep. 1983 to Mar. 1999 were reviewed. Of 151 cases, 72 were squamous cell carcinoma (SCC), 44 were adenocarcinoma, 16 were sarcoma, and 19 were other histological types; according to 1997 UICC classification, 7 were stage II, 55 were stage III, and 89 were stage IV; 66 patients received combined therapy of surgery and radiotherapy, 14 received surgery alone, 25 received radiotherapy alone, 39 received other treatments, and 7 gave up treatment. All patients were followed up for more than 5 years. Influences of clinicopathologic factors on prognosis of patients with maxillary sinus malignant neoplasms were analyzed by Kaplan-Meier method, and Cox regression model with SPSS10.0 software.
Five-year overall survival rate of patients of </=40 years old was 55.7%, that of patients of >40 years old was 33.3%(P=0.030); that of patients with SCC was 30.2%, of patients with adenocarcinoma was 57.5%, of patients with sarcoma was 24.3%, of patients with tumor of other histological types was 50.7% (P=0.011); that of patients with tumor of stage II, III, and IV were 85.7%, 45.8%, and 32.7%, respectively (P=0.029); that of patients with cervical metastases was 14.4%, of patients without cervical metastases was 44.1% (P=0.005); that of patients with distant metastases was 14.3%, of patients without distant metastases was 41.1% (P=0.011); that of patients without treatment was 14.3%, of patients treated with surgery alone was 42.9%, of patients treated with radiotherapy alone was 32.3%, of patients treated with combined therapy of surgery and radiotherapy was 50.8%, of patients treated with other treatments was 29.1% (P=0.004). Univariate survival analysis showed that the above 6 factors were prognostic factors of patients with maxillary sinus malignant neoplasms. Multivariate analysis showed that combination of surgery and radiotherapy (P=0.004, OR< 1), clinical stage (P=0.025, OR >1), SCC (P=0.016, OR >1), and sarcoma (P=0.003, OR >1) were independent prognostic factors of patients with maxillary sinus malignant neoplasms.
For maxillary sinus malignant neoplasms, patients with SCC or sarcoma had poorer survival than patients with adenocarcinoma or other histological types of tumor; patients with sarcoma had poorer survival than patients with SCC. The higher the patient's clinical stage was, the worse his prognosis was. Combination of surgery and radiotherapy may be the best treatment for patients with maxillary sinus malignant neoplasms.
上颌恶性肿瘤患者的5年生存率较低，其预后因素尚不明确。本研究旨在探讨上颌窦恶性肿瘤的预后因素。
回顾性分析1983年9月至1999年3月在中山大学肿瘤防治中心初治的151例上颌窦恶性肿瘤住院患者的病历资料。151例患者中，鳞状细胞癌（SCC）72例，腺癌44例，肉瘤16例，其他组织学类型19例；按1997年UICC分期，Ⅱ期7例，Ⅲ期55例，Ⅳ期89例；66例患者接受手术加放疗综合治疗，14例仅行手术治疗，25例仅行放射治疗，39例接受其他治疗，7例放弃治疗。所有患者均随访5年以上。采用Kaplan-Meier法及Cox回归模型，运用SPSS10.0软件分析临床病理因素对患者预后的影响。
≤40岁患者的5年总生存率为55.7%，>40岁患者为33.3%（P=0.030）；SCC患者为30.2%，腺癌患者为57.5%，肉瘤患者为24.3%，其他组织学类型肿瘤患者为50.7%（P=0.011）；Ⅱ期、Ⅲ期、Ⅳ期患者分别为85.7%、45.8%、32.7%（P=0.029）；有颈部转移患者为14.4%，无颈部转移患者为44.1%（P=0.005）；有远处转移患者为14.3%，无远处转移患者为41.1%（P=0.011）；未治疗患者为14.3%，仅行手术治疗患者为42.9%，仅行放射治疗患者为32.3%，手术加放疗综合治疗患者为50.8%，接受其他治疗患者为29.1%（P=0.004）。单因素生存分析显示上述6个因素为上颌窦恶性肿瘤患者的预后因素。多因素分析显示，手术加放疗综合治疗（P=0.004，OR<1）、临床分期（P=0.025，OR>1）、SCC（P=0.016，OR>1）及肉瘤（P=0.003，OR>1）是上颌窦恶性肿瘤患者的独立预后因素。
对于上颌窦恶性肿瘤，SCC或肉瘤患者的生存率低于腺癌或其他组织学类型肿瘤患者；肉瘤患者的生存率低于SCC患者。患者临床分期越高，预后越差。手术加放疗综合治疗可能是上颌窦恶性肿瘤患者的最佳治疗方法。
