Bhayani Mihir K, Yilmaz Turker, Sweeney Alex, Calzada Gabriel, Roberts Dianna B, Levine Nicholas B, DeMonte Franco, Hanna Ehab Y, Kupferman Michael E
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Head Neck. 2014 Oct;36(10):1490-6. doi: 10.1002/hed.23485. Epub 2014 Jan 29.
Adenocarcinoma is a rare tumor of the sinonasal tract. The purpose of this study was to characterize a single institution's experience with this malignancy.
Retrospective review was performed of patients with adenocarcinoma of the sinonasal tract from 1993 to 2009. Demographic data, disease presentation, treatment, and survival rates were collected and evaluated.
We identified 66 patients with sinonasal adenocarcinoma; 48 were men and 18 women. Average age at time of diagnosis was 57.1 years (range, 20-88 years), and median follow-up was 55.3 months (range, 1-238 months). The ethmoid sinus (38%) and nasal cavity (36%) were the most common sites of origin. Nasal obstruction (36%), epistaxis (30%), and nasal discharge (21%) were the most common presenting symptoms. Fifty-one percent of patients presented with T1 or T2 tumors. Surgery was the primary form of treatment in 81% of patients. Twenty-six percent of surgical patients underwent an endoscopic tumor resection. Adjuvant radiation was utilized in 50% of patients and chemotherapy in 10%. Recurrence was seen in 24 patients (37%): 29% recurred locally and 7.6% recurred distantly. The overall 5-year survival was 65.9%. Survival was decreased significantly in patients with T4 tumors (p < .05), high-grade histology (p < .05), and sphenoid sinus involvement (p < .05). Survival was not affected by surgical approach between endoscopic and open approaches (p = .76).
Sinonasal adenocarcinomas are commonly identified in the sinonasal cavity and are associated with a relatively favorable prognosis, despite a substantial local failure rate of 30%. Advanced-stage tumors, sphenoid sinus and skull base invasion, and high-grade histology portend poor prognosis. In our experience, endoscopic resection was not associated with adverse outcomes and suggests that this minimally invasive approach can provide acceptable oncologic outcomes in selected patients.
腺癌是鼻窦罕见的肿瘤。本研究的目的是描述单一机构对这种恶性肿瘤的治疗经验。
对1993年至2009年鼻窦腺癌患者进行回顾性研究。收集并评估人口统计学数据、疾病表现、治疗方法及生存率。
我们共确定66例鼻窦腺癌患者，其中男性48例，女性18例。诊断时的平均年龄为57.1岁（范围20 - 88岁），中位随访时间为55.3个月（范围1 - 238个月）。筛窦（38%）和鼻腔（36%）是最常见的原发部位。鼻塞（36%）、鼻出血（30%）和流涕（21%）是最常见的症状。51%的患者表现为T1或T2期肿瘤。81%的患者以手术作为主要治疗方式。26%的手术患者接受了内镜下肿瘤切除。50%的患者接受了辅助放疗，10%的患者接受了化疗。24例患者（37%）出现复发：29%为局部复发，7.6%为远处复发。总体5年生存率为65.9%。T4期肿瘤患者（p < 0.05）、高组织学分级患者（p < 0.05）和蝶窦受累患者（p < 0.05）的生存率显著降低。内镜手术与开放手术的手术方式对生存率无影响（p = 0.76）。
鼻窦腺癌常见于鼻窦腔，尽管局部失败率高达30%，但其预后相对良好。晚期肿瘤、蝶窦和颅底侵犯以及高组织学分级预示预后不良。根据我们的经验，内镜切除不会带来不良后果，提示这种微创方法在部分患者中可获得可接受的肿瘤治疗效果。
