Bell Diana, Saade Rami, Roberts Dianna, Ow Thomas J, Kupferman Michael, DeMonte Franco, Hanna Ehab Y
Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
Head Neck Pathol. 2015 Mar;9(1):51-9. doi: 10.1007/s12105-014-0547-3. Epub 2014 May 8.
Esthesioneuroblastoma (ENB) is derived from the specialized olfactory neuroepithelium. Hyams grading and Kadish staging have been used to prognosticate and to guide treatment decisions. In this study, we sought to validate the prognostic utility of these systems in a large ENB cohort. We retrospectively analyzed the records of patients with ENB who had been evaluated and treated at our institution. The association of grade and stage with prognostic outcome was assessed; the Kaplan-Meier estimator was used to generate 5-year OS and DFS curves. Out of 124 cases we identified, 121 were assessed for grading and 109 for staging. Review of the tissue samples revealed that 62 % of tumors were low grade (I/II) and 21 % were high grade (III/IV); 17 % of tumors were metastasis. The OS rate was 75 % at 5 years. The DFS was 60 % at 5 years. The OS was significantly worse for metastatic ENB (low-grade ENB vs metastatic ENB p = 0.01598); the DFS was significantly worse for high grade versus low grade ENB. Of the 109 cases that had been staged, 16 % were stage A, 33 % stage B, 43 % stage C, and 8 % stage D. In the A, B, and C groups, there were no significant differences between recurrence, distant metastasis, or 5-year survival rates. Statistical significance was not reached with the T, N, M and overall staging system. Age cutoff of 65 years reliably predicted OS. High grade of ENB was significantly associated with poor outcome, while advanced stage was not associated with poor outcome in this large cohort. Grading should certainly be considered in prognostication and treatment decisions for ENB.
嗅神经母细胞瘤(ENB)起源于特殊的嗅神经上皮。海姆斯分级和卡迪什分期已被用于预测和指导治疗决策。在本研究中,我们试图在一个大型ENB队列中验证这些系统的预后效用。我们回顾性分析了在我们机构接受评估和治疗的ENB患者的记录。评估了分级和分期与预后结果的相关性;使用Kaplan-Meier估计器生成5年总生存期(OS)和无病生存期(DFS)曲线。在我们确定的124例病例中,121例进行了分级评估,109例进行了分期评估。对组织样本的审查显示,62%的肿瘤为低级别(I/II),21%为高级别(III/IV);17%的肿瘤有转移。5年总生存率为75%。5年无病生存率为60%。转移性ENB的总生存期明显更差(低级别ENB与转移性ENB相比,p = 0.01598);高级别ENB与低级别ENB相比,无病生存期明显更差。在已分期的109例病例中,16%为A期,33%为B期,43%为C期,8%为D期。在A、B和C组中,复发、远处转移或5年生存率之间无显著差异。T、N、M和总体分期系统未达到统计学显著性。65岁的年龄界限可可靠地预测总生存期。在这个大型队列中,ENB的高级别与不良预后显著相关,而晚期与不良预后无关。在ENB的预后评估和治疗决策中,分级当然应该被考虑。
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