Wustrow J, Rudert H, Diercks M, Beigel A
Universitäts-Hals-Nasen-Ohren-Klinik Kiel.
Strahlenther Onkol. 1989 Jun;165(6):468-73.
272 patients with tumours of the nasal cavity and paranasal sinuses were followed up from 1949 until 1982 at the ENT Department of the University Hospital in Kiel. 53% of the tumours were classified as squamous cell or undifferentiated carcinomata. At an early stage such tumours cause nonspecific symptoms which may mimic those of chronic sinusitis. Early diagnosis is usually hindered by the occult growth within the facial skeleton and especially by the minor symptoms caused by tumours of the paranasal sinuses. In contrast, tumours of the nasal cavity cause symptoms at an early stage and consequently are diagnosed early. The majority of cases with tumours of the paranasal sinuses present at an advanced stage (T3 to T4) in 70% of cases. The most common site of squamous cell carcinoma is the maxillary sinus (50%). Distant metastases and regional lymph node metastases are rarely seen at presentation regardless of the size of the primary tumour. Metastases usually indicate a tumour dependent death in the near future. The main prognostic indicators are the size of the tumour (significantly worse prognosis for T4 in comparison to T2 or T3 tumours) and the localisation (significantly better prognosis for tumours of the floor of the nasal cavity or the nasal septum compared to tumours of the paranasal sinuses). The age of the patient or the degree of differentiation of the tumour did not influence on the survival rate. Tumour-dependent deaths rarely occur after more than five years. Patients were assigned to two treatment groups and matched according to the tumour stage. One group received surgery only, whereas the second group received a combined treatment of surgery with subsequent radiotherapy. There was a significant difference between the two groups in favour of the surgical treatment. According to these data we recommend surgical excision without postoperative irradiation in cases where complete removal of the tumor has been histologically proven.
1949年至1982年期间，基尔大学医院耳鼻喉科对272例鼻腔和鼻窦肿瘤患者进行了随访。53%的肿瘤被归类为鳞状细胞癌或未分化癌。在早期，这类肿瘤会引起非特异性症状，可能类似于慢性鼻窦炎的症状。早期诊断通常受到面部骨骼内隐匿性生长的阻碍，尤其是鼻窦肿瘤引起的轻微症状。相比之下，鼻腔肿瘤在早期就会引起症状，因此能早期诊断。鼻窦肿瘤的大多数病例在晚期（T3至T4）出现，占病例的70%。鳞状细胞癌最常见的部位是上颌窦（50%）。无论原发肿瘤大小如何，就诊时很少见到远处转移和区域淋巴结转移。转移通常预示着在不久的将来肿瘤相关死亡。主要的预后指标是肿瘤大小（与T2或T3肿瘤相比，T4肿瘤的预后明显更差）和肿瘤位置（与鼻窦肿瘤相比，鼻腔底部或鼻中隔肿瘤的预后明显更好）。患者的年龄或肿瘤的分化程度对生存率没有影响。超过五年后很少发生肿瘤相关死亡。患者被分为两个治疗组，并根据肿瘤分期进行匹配。一组仅接受手术治疗，而第二组接受手术联合后续放疗的综合治疗。两组之间存在显著差异，支持手术治疗。根据这些数据，我们建议在组织学证实肿瘤已完全切除的情况下，进行手术切除且不进行术后放疗。
