McKay Shawn P, Shibuya Terry Y, Armstrong William B, Wong Hau-Sin, Panossian Apraham M, Ager Joel, Mathog Robert H
Department of Otolaryngology--Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48202, USA.
Am J Otolaryngol. 2007 Sep-Oct;28(5):294-301. doi: 10.1016/j.amjoto.2006.09.007.
To evaluate patients with squamous cell carcinoma of the paranasal sinus and skull base for factors that might predict clinical outcome.
A multi-institutional 13-year retrospective review of anterior skull base malignancies.
Of 73 patients with anterior skull base malignancies, squamous cell carcinoma was the most prevalent-30 patients or 41%. Twenty-three patients underwent craniofacial surgery with or without adjuvant chemotherapy. Seven patients, deemed unresectable or not willing to have surgery, were treated with standard radiation protocols often with chemotherapy. The 3- and 5-year survival rates after surgery were 32% and 16%, respectively, compared to a 28% survival rate at 3 and 5 years for the nonsurgical group. Most tumors were in advanced stages accounting for a relatively poor survival in both groups. A Cox regression analysis demonstrated that age (P = .0172) was an independent determinant of poor outcome. Although 3- and 5-year survival of tumors free of sphenoid sinus, dura, retromaxillary, and ptyerygoid space, and orbit treated with surgery showed no significant difference to those patients with involvement, their median time of survival was increased for all anatomical regions.
Squamous cell carcinoma of the sinus invading the skull base carries a very poor prognosis regardless of treatment modality. Surgery with adjunctive radiotherapy and/or chemotherapy offers a survival advantage over nonsurgical methods, but treatment should be individualized weighing prognostic factors, such as age, stage, and anatomical extension with morbidity of treatment.
评估鼻窦和颅底鳞状细胞癌患者可能预测临床结局的因素。
对前颅底恶性肿瘤进行多机构13年的回顾性研究。
73例前颅底恶性肿瘤患者中，鳞状细胞癌最为常见——30例，占41%。23例患者接受了颅面手术，伴或不伴辅助化疗。7例被认为无法切除或不愿接受手术的患者接受了通常联合化疗的标准放疗方案。手术后3年和5年生存率分别为32%和16%，而非手术组3年和5年生存率为28%。大多数肿瘤处于晚期，导致两组生存率相对较低。Cox回归分析表明，年龄（P = .0172）是预后不良的独立决定因素。尽管手术治疗的未累及蝶窦、硬脑膜、上颌后间隙、翼状间隙和眼眶的肿瘤3年和5年生存率与累及这些部位的患者无显著差异，但所有解剖区域的中位生存时间均有所延长。
侵犯颅底的鼻窦鳞状细胞癌无论采用何种治疗方式，预后都非常差。手术联合辅助放疗和/或化疗比非手术方法具有生存优势，但治疗应个体化，权衡预后因素，如年龄、分期、解剖范围以及治疗的并发症。
