Kaplan Daniel James, Kim Jee Hong, Wang Eric, Snyderman Carl
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2016 Jan;154(1):104-12. doi: 10.1177/0194599815606699. Epub 2015 Sep 30.
Identify prognostic factors after salvage surgery for recurrent sinonasal malignancy (SNM).
Case series with chart review.
University of Pittsburgh Medical Center.
Forty-two patients who underwent curative surgery for locally recurrent SNM ± adjuvant therapy from June 5, 2000, to December 19, 2012. Patients without follow-up were excluded.
Chart review with established prognostic indicators for primary malignancies. Statistical analysis included Kaplan-Meier log-rank test, Fisher's exact test, Student's t test, and Cox regression.
Forty-two patients met inclusion criteria: 38.5% developed a second recurrence, and 21.4% had metastases following treatment. The average disease-free interval (DFI) was 26.9 months (range, 2-90 months). DFI was significantly affected by ethmoid versus nonethmoid site (P = .049), histology (P = .012), carotid artery involvement (P = .008), perineural extension (P = .006), and clival invasion (P = .015). The overall survival rates at 6 months, 12 months, and 5 years following surgery were 83.3%, 69%, and 47.6%, respectively. Survival was affected by histology (P = .014), stratified grade (P = .042), tumor extension into the orbit (P = .019), carotid artery (P = .001), perineural space (P = .028), and clivus (P = .022). Complications occurred in 28.6% of patients and were associated with histology (P = .04). Length of hospital stay related to treatment was affected by histology (P = .009), grade (P = .013), and postoperative complication (P < .001). The median percentage of time hospitalized was 8%, and 43% of patients who died within 12 months spent >10% of their remaining days in the hospital.
High-risk histologic subtype (melanoma, sinonasal undifferentiated carcinoma, adenocarcinoma, neuroendocrine cancer, sarcoma, and squamous cell carcinoma), grade, and orbital and skull base involvement negatively affect survival and/or DFI for patients with local recurrence of SNM. Improved stratification of patients can be used to guide decision making for patients with recurrent SNM and to avoid inappropriate surgery.
确定复发性鼻窦恶性肿瘤（SNM）挽救性手术后的预后因素。
病历回顾的病例系列研究。
匹兹堡大学医学中心。
2000年6月5日至2012年12月19日期间接受局部复发性SNM根治性手术及±辅助治疗的42例患者。排除无随访资料的患者。
采用原发性恶性肿瘤既定的预后指标进行病历回顾。统计分析包括Kaplan-Meier对数秩检验、Fisher精确检验、Student t检验和Cox回归分析。
42例患者符合纳入标准：38.5%出现二次复发，21.4%在治疗后发生转移。平均无病生存期（DFI）为26.9个月（范围2 - 90个月）。筛窦与非筛窦部位（P = 0.049）、组织学类型（P = 0.012）、颈动脉受累情况（P = 0.008）、神经周围侵犯（P = 0.006）和斜坡侵犯（P = 0.015）对DFI有显著影响。术后6个月、12个月和5年的总生存率分别为83.3%、69%和47.6%。生存率受组织学类型（P = 0.014）、分层分级（P = 0.042）、肿瘤侵犯眼眶（P = 0.019）、颈动脉（P = 0.001）、神经周围间隙（P = 0.028）和斜坡（P = 0.022）影响。28.6%的患者发生并发症，且与组织学类型有关（P = 0.04）。与治疗相关的住院时间受组织学类型（P = 0.009）、分级（P = 0.013）和术后并发症（P < 0.001）影响。住院时间的中位数百分比为8%，12个月内死亡的患者中有43%在剩余时间里有超过10%的时间住院。
高危组织学亚型（黑色素瘤、鼻窦未分化癌、腺癌、神经内分泌癌、肉瘤和鳞状细胞癌）、分级以及眼眶和颅底受累对局部复发性SNM患者的生存和/或DFI有负面影响。改进患者分层可用于指导复发性SNM患者的决策，并避免不适当的手术。
