嗅神经母细胞瘤的淋巴结转移模式及选择性颈部放疗的价值

Spread patterns of lymph nodes and the value of elective neck irradiation for esthesioneuroblastoma.

作者信息

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

机构信息

Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

出版信息

Radiother Oncol. 2015 Nov;117(2):328-32. doi: 10.1016/j.radonc.2015.10.002. Epub 2015 Nov 7.

DOI:10.1016/j.radonc.2015.10.002

PMID:26558687

Abstract

OBJECTIVES

This study was aimed to characterize patterns of lymphatic spread and assess the value of prophylactic elective neck irradiation (ENI) for esthesioneuroblastoma (ENB).

METHODS

A retrospectively analysis of 116 patients with newly diagnosed ENB at our institution over 35-year period was undertaken.

RESULTS

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).

CONCLUSIONS

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.

摘要

目的

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。

方法

对我院35年间新诊断的116例ENB患者进行回顾性分析。

结果

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）。