Department of Otorhinolaryngology, Pellegrin Hospital, Centre F-X Michelet, Bordeaux Cedex, France.
Ann Surg Oncol. 2010 Apr;17(4):1127-34. doi: 10.1245/s10434-010-0933-3. Epub 2010 Feb 10.
To assess management options for ethmoid adenocarcinoma.
Retrospective review over 28 years.
Ninety-five patients were included. Statistical analysis using the Kaplan-Meier method was performed to establish survival rates, and univariate analysis to determine prognostic factors. Independent chi(2) test was used to compare survival rates between T3 and T4a stages operated by transfacial and craniofacial approaches, respectively.
Mean age was 64 years, and 76% patients were stage T3 or T4. Three patients had node metastasis, none of whom had distant metastases at time of diagnosis. Eighty-three percent of patients received surgery and adjuvant radiotherapy on tumor bed. Mean follow-up was 5 years. The recurrence and metastasis rate were 31 and 9% at median time of 3 years, respectively. The disease-specific 5- and 10-year survival rates were 78 and 64%, respectively. The disease-free survival rate was 61 and 44%, respectively, at the same time points. Meningo-encephalic (P = 10(-8)), orbit or infratemporal fossae (P = 0.046), and frontal sinus extension (P = 0.02) negatively impacted survival. There was no statistically significant difference in survival rate between T3 and T4a.
Our data suggest that less surgical treatment may be needed than is usually advocated for T1-T4a tumors and that surgery alone may be appropriate for T1-T3 tumors that have been resected with adequate margins in those patients for whom excellent follow-up is anticipated. No neck irradiation is indicated for N0 disease.
评估筛窦腺癌的治疗选择。
回顾性研究超过 28 年。
共纳入 95 例患者。采用 Kaplan-Meier 法进行统计分析以建立生存率，并进行单因素分析以确定预后因素。采用独立的卡方检验比较经面中部入路和颅面联合入路分别治疗 T3 和 T4a 期肿瘤的患者的生存率。
平均年龄为 64 岁，76%的患者为 T3 或 T4 期。3 例患者有淋巴结转移，诊断时均无远处转移。83%的患者接受了手术和肿瘤床辅助放疗。平均随访时间为 5 年。中位随访 3 年时，复发和转移率分别为 31%和 9%。疾病特异性 5 年和 10 年生存率分别为 78%和 64%。相同时间点的无病生存率分别为 61%和 44%。脑膜脑（P = 10(-8)）、眼眶或颞下窝（P = 0.046）和额窦延伸（P = 0.02）对生存率有负面影响。T3 和 T4a 之间的生存率无统计学差异。
我们的数据表明，对于 T1-T4a 肿瘤，可能需要比通常提倡的更少的手术治疗，对于那些预计能够进行良好随访的患者，已切除并具有足够切缘的 T1-T3 肿瘤，单独手术可能是合适的。对于 N0 疾病，不需要颈部照射。
