Yin Zhen-zhen, Luo Jing-wei, Gao Li, Yi Jun-lin, Huang Xiao-dong, Qu Yuan, Wang Kai, Zhang Shi-ping, Xiao Jian-ping, Xu Guo-zhen, Li Ye-xiong
Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Radiother Oncol. 2015 Nov;117(2):328-32. doi: 10.1016/j.radonc.2015.10.002. Epub 2015 Nov 7.
This study was aimed to characterize patterns of lymphatic spread and assess the value of prophylactic elective neck irradiation (ENI) for esthesioneuroblastoma (ENB).
A retrospectively analysis of 116 patients with newly diagnosed ENB at our institution over 35-year period was undertaken.
32 patients (28%) presented lymph node metastasis at initial diagnosis, the common sites involved were level II, Ib, level III and VIIa. Among 80 N-negative patients staged in Modified Kadish B/C, 50 patients were delivered with ENI, 30 patients were not. The 5-year regional failure-free survival was 98% in patients treated with ENI and 75% in patients without ENI (p=0.005), regional failure rate decreased significantly from 23% (7/30) to 2% (1/50) after ENI (p=0.002). Multivariate analysis also suggested that ENI was an independent favorable predictor for regional controlling (HR, 0.102; 95% CI: 0.012-0.848; p=0.035).
This is the largest cohort of ENB so far in a single institute, and also the first detailed description of nodal spread patterns of N-positive ENB. Elective neck irradiation reduced the regional failure significantly and should be recommended as a part of initial treatment strategy for patients staged with Modified Kadish B/C.
本研究旨在描述嗅神经母细胞瘤（ENB）的淋巴转移模式，并评估预防性选择性颈部照射（ENI）对嗅神经母细胞瘤的价值。
对我院35年间新诊断的116例ENB患者进行回顾性分析。
32例（28%）患者初诊时出现淋巴结转移，常见受累部位为Ⅱ区、Ⅰb区、Ⅲ区和Ⅶa区。在改良Kadish B/C分期的80例N阴性患者中，50例接受了ENI，30例未接受。接受ENI治疗的患者5年区域无复发生存率为98%，未接受ENI治疗的患者为75%（p = 0.005），ENI后区域复发率从23%（7/30）显著降至2%（1/50）（p = 0.002）。多因素分析还表明，ENI是区域控制的独立有利预测因素（HR，0.102；95%CI：0.012 - 0.848；p = 0.035）。
这是迄今为止单个机构中最大的ENB队列研究，也是对N阳性ENB淋巴结转移模式的首次详细描述。选择性颈部照射显著降低了区域复发率，应推荐作为改良Kadish B/C分期患者初始治疗策略的一部分。
