Liu Wen-sheng, Xu Zhen-gang, Gao Li, Tang Ping-zhang, Xu Guo-zhen, Zhang Guo-fen
Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100021, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011 May;46(5):402-7.
To study the clinical characters, the outcomes of treatments and the factors affecting long-term treatment results of adenoid cystic carcinoma (ACC) of the maxillary sinus.
The clinical data of 80 patients with ACC of the maxillary sinus treated initially were analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression.
The 5-, 10- and 15-year cumulative overall survival rates were 65.2%, 37.1%, 26.3% respectively and 5-, 10-, and 15-year disease-free survival rates 50.7%, 30.7% and 24.5% respectively. The 5-, 10- and 15-year cumulative local control rates were 68.5%, 47.3% and 47.3% respectively and the cumulative distant metastasis rate were 32.8%, 48.8% and 48.8% respectively. Prognostic factors affecting survival included T stage, pathologic grade and the modes of treatment (P < 0.05). Patients with combined therapy composed of surgery and radiation had a better local control, compared with surgery or radiation alone (χ(2) = 18.33, P < 0.01), and surgery combined with postoperative radiation was prior to preoperative radiation combined with surgery (χ(2) = 6.64, P < 0.05). Patients treated with surgery combined with preoperative radiation, either with doses of ≥ 60 Gy or with negative margins, had a better local control, compared with doses < 60 Gy and with positive margins (χ(2) = 5.06, P < 0.05). The most of patients (62.8%) died of local recurrence.
The most of failure was due to recurrence. Combined therapy composed of surgery and radiation improves the local control and survival in patients with ACC of the maxillary sinus, compared with surgery or radiation alone. Surgery combined with postoperative radiation provides the best overall survival and local control and should be the first choice of treatments.
研究上颌窦腺样囊性癌（ACC）的临床特征、治疗效果及影响长期治疗结果的因素。
回顾性分析80例初治上颌窦ACC患者的临床资料。采用Kaplan-Meier法分析生存率、局部复发率和远处转移率。通过Log-rank检验和Cox回归分析预后因素。
5年、10年和15年累计总生存率分别为65.2%、37.1%、26.3%，无病生存率分别为50.7%、30.7%和24.5%。5年、10年和15年累计局部控制率分别为68.5%、47.3%和47.3%，远处转移累计率分别为32.8%、48.8%和48.8%。影响生存的预后因素包括T分期、病理分级和治疗方式（P<0.05）。与单纯手术或放疗相比，手术联合放疗的综合治疗患者局部控制更好（χ(2)=18.33，P<0.01），且手术联合术后放疗优于术前放疗联合手术（χ(2)=6.64，P<0.05）。与剂量<60 Gy和切缘阳性相比，接受手术联合术前放疗且剂量≥60 Gy或切缘阴性的患者局部控制更好（χ(2)=5.06，P<0.05）。大多数患者（62.8%）死于局部复发。
大多数治疗失败是由于复发。与单纯手术或放疗相比，手术联合放疗的综合治疗可提高上颌窦ACC患者的局部控制率和生存率。手术联合术后放疗可提供最佳的总生存率和局部控制率，应作为首选治疗方式。
