Miglani Amar, Patel Samir H, Kosiorek Heidi E, Hinni Michael L, Hayden Richard E, Lal Devyani
Am J Rhinol Allergy. 2017 May 1;31(3):200-204. doi: 10.2500/ajra.2017.31.4435.
Endoscopic endonasal resection (EER) of sinonasal mucosal melanoma (SMM) is a newer surgical alternative to traditional external and/or open resection (OR). Studies on long-term outcomes are necessary to validate EER for this aggressive sinonasal malignancy.
To compare outcomes of EER versus OR in SMM.
A case series of patients who underwent surgical resection of SMM at a tertiary-care institution (2000-2015) was studied retrospectively. Demographics, tumor site and stage, surgical approach, surgical margin status, local control, and survival were compared between those who underwent EER and OR.
Twenty-two patients met inclusion criteria. Nine underwent EER and 13 underwent OR. The mean age in the EER and OR groups was similar, 78.7 and 72.3 years, respectively. Two-thirds of patients were women (EER, 66.7%; OR, 61.5%). The nasal cavity was the most common primary tumor site (EER, 77.8%; OR, 84.6%). The local tumor stage in both groups was similar, with the majority of cases being T4 (EER, 55.6%; OR, 61.5%; p = 0.99). Negative margins were achieved in all EERs and in 69.2% of ORs. Median follow-up was 25.0 months for the overall group (range, 1.7-172.9 months), 32.6 months (range, 3.4-58.7 months) for EER and 14.1 months (range, 1.7-172.9 months) for OR cohorts. The 5-year overall survival was statistically similar in both groups (EER, 53.3%; OR, 22.7%; p = 0.214) as was disease-free survival (EER, 55.6%; OR, 22.8%; p = 0.178). Local control, however, was significantly higher in the EER cohort (EER, 85.7%; OR, 37.6%; p = 0.026).
In carefully selected patients with sinonasal melanoma, endoscopic surgery with an experienced team may offer comparable survival and improved local control over open surgery. Prospective, multicentered studies with larger cohorts are needed to validate these results.
鼻窦黏膜黑色素瘤（SMM）的鼻内镜下鼻内切除术（EER）是一种相较于传统外部和/或开放式切除术（OR）的新型手术方式。对于这种侵袭性鼻窦恶性肿瘤，有必要开展长期预后研究以验证EER的效果。
比较EER与OR治疗SMM的疗效。
回顾性研究一家三级医疗机构（2000 - 2015年）中接受SMM手术切除的患者病例系列。比较接受EER和OR治疗的患者的人口统计学资料、肿瘤部位和分期、手术方式、手术切缘状态、局部控制情况和生存率。
22例患者符合纳入标准。9例接受EER，13例接受OR。EER组和OR组的平均年龄相似，分别为78.7岁和72.3岁。三分之二的患者为女性（EER组为66.7%；OR组为61.5%）。鼻腔是最常见的原发肿瘤部位（EER组为77.8%；OR组为84.6%）。两组的局部肿瘤分期相似，大多数病例为T4期（EER组为55.6%；OR组为61.5%；p = 0.99）。所有接受EER的患者均获得阴性切缘，OR组为69.2%。总体组的中位随访时间为25.0个月（范围1.7 - 172.9个月），EER组为32.6个月（范围3.4 - 58.7个月），OR组为14.1个月（范围1.7 - 172.9个月）。两组的5年总生存率在统计学上相似（EER组为53.3%；OR组为22.7%；p = 0.214），无病生存率也相似（EER组为55.6%；OR组为22.8%；p = 0.178）。然而，EER组的局部控制率显著更高（EER组为85.7%；OR组为37.6%；p = 0.026）。
在精心挑选的鼻窦黑色素瘤患者中，由经验丰富的团队进行内镜手术可能与开放手术具有相当的生存率，且局部控制效果更佳。需要开展前瞻性、多中心、更大样本量的研究来验证这些结果。
