Guo Z M, Liu W W, He J H
Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, China.
Clin Otolaryngol. 2009 Aug;34(4):322-7. doi: 10.1111/j.1749-4486.2009.01952.x.
The purpose of this study was to investigate the clinical manifestations, Epstein-Barr virus (EBV) serology, and treatment outcome of patients with nasopharyngeal adenocarcinoma (NPAC).
A retrospective study of clinical data from consecutive patients with NPAC identified between 1964 and 2000.
A tertiary cancer center in China.
Forty-eight patients diagnosed with NPAC.
Crosstabs and chi-square test were conducted to study the association of positive VCA-IgA levels among different pathological types of NPAC, and also to compare the proportions of local control rates in patients treated with different modalities. The survival rate was calculated using the Kaplan-Meier method, and the Log Rank test was used to compare the survival rates considering different factors. To balance the distribution bias, a multivariate COX model survival analysis was also performed.
Of the 48 NPAC patients identified, 45% presented with cervical metastasis. Pathologically, 58% of NPAC cases were common type and 42% were salivary gland type. The positive rate for the EBV antibody VCA-IgA in all patients was 53% and only 24% in the salivary gland type of NPAC. The overall local control rate and the 5-year disease-free survival rates were 87% and 65% respectively. Patients treated with surgery plus radiotherapy (RT) had a significantly higher 5-year disease-free survival rate than patients receiving RT alone (89%versus 75% respectively) (P = 0.039). Multivariate analysis confirmed that treatment modality was the significant factor influencing patient survival (P = 0.027) and the pathological type was not a factor predicting survival.
Nasopharyngeal adenocarcinoma is a distinct entity in all types of nasopharyngeal carcinoma and EBV serology has limited value in its diagnosis. The combination of surgery and RT should be considered for treatment of early lesions of NPAC.
本研究旨在调查鼻咽腺癌（NPAC）患者的临床表现、EB病毒（EBV）血清学及治疗结果。
对1964年至2000年间确诊的连续性NPAC患者的临床资料进行回顾性研究。
中国一家三级癌症中心。
48例被诊断为NPAC的患者。
进行交叉表和卡方检验，以研究不同病理类型的NPAC中VCA-IgA阳性水平的相关性，并比较不同治疗方式患者的局部控制率。采用Kaplan-Meier法计算生存率，并用对数秩检验比较不同因素下的生存率。为平衡分布偏差，还进行了多变量COX模型生存分析。
在确诊的48例NPAC患者中，45%出现颈部转移。病理上，58%的NPAC病例为常见类型，42%为涎腺型。所有患者中EBV抗体VCA-IgA的阳性率为53%，而涎腺型NPAC中仅为24%。总体局部控制率和5年无病生存率分别为87%和65%。接受手术加放疗（RT）的患者5年无病生存率显著高于单纯接受RT的患者（分别为89%和75%）（P = 0.039）。多变量分析证实，治疗方式是影响患者生存的重要因素（P = 0.027），而病理类型不是预测生存的因素。
鼻咽腺癌在所有鼻咽癌类型中是一个独特的实体，EBV血清学在其诊断中的价值有限。对于NPAC早期病变的治疗应考虑手术与RT联合应用。
