Wang Hui-Gang, Shen Cong-Xiang, Chen Fang, Li Guan-Xue, Wang Xiao-Qi, Wen Zhong
Department of Otorhinolaryngology-Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China. E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2017 Jun 20;37(6):847-852. doi: 10.3969/j.issn.1673-4254.2017.06.24.
To evaluate the clinical characteristics, treatment and prognosis of advanced adenoid cystic carcinoma (ACC) in the nasal cavity and paranasal sinuses.
Twenty-one patients with advanced ACC in the nasal cavity and paranasal sinuses were treated in our department between February, 2007 and May, 2016. The clinical manifestations, T-stage, N-status, treatment, histological grade, recurrence and distant metastasis of the tumors were analyzed. Univariate survival analysis was performed with Kaplan-Meier method and Log-rank test, and the factors affecting the prognosis of the patients were explored using multivariate analysis with Cox proportional hazard model.
Among the 21 patients, 10 (47.6%) had ACC containing less than 30% of solid tumor tissues and their overall survival rates at 1, 3, and 5 years were 100%, 100% and 70%, respectively; in the 11 cases (52.4%) with solid tumor tissues no less than 30%, the overall survival rates at 1, 3, and 5 years were 70%, 40% and 10%, respectively, showing significant differences between the two groups (P=0.02). The Log-rank test and survival analysis using the covariate variable model curve indicated a significant impact of the pathological classification on the patients' prognosis. The patients in T3 stage had slightly better prognosis than those in T4 stage; tumors originating from the maxillary sinus had a slightly better prognosis than those from the sphenoid sinus. Surgery combined with radiotherapy resulted in better outcomes of the patients than surgery or radiotherapy alone. Multiariable Cox regression model analysis showed that the pathological classification (P=0.045) and the disease course (P=0.028) were closely related with the prognosis of the patients.
ACC in the nasal cavity and paranasal sinuses has a low incidence without specific symptoms. Its early diagnosis can be difficult, and most of the patients are in advanced stage upon diagnosis. We recommend comprehensive treatments combining surgery, postoperative radiotherapy and chemotherapy for these patients. The pathological classification, disease course, lesion site, clinical stage, treatment approache, compromise of the peripheral nerves, status at the edge of resection, and postoperative radiotherapy dose can all be factors affecting the prognosis of patients with advanced ACC.
评估鼻腔及鼻窦晚期腺样囊性癌（ACC）的临床特征、治疗方法及预后。
回顾性分析2007年2月至2016年5月在我科治疗的21例鼻腔及鼻窦晚期ACC患者的临床表现、T分期、N状态、治疗方法、组织学分级、肿瘤复发及远处转移情况。采用Kaplan-Meier法和Log-rank检验进行单因素生存分析，并用Cox比例风险模型进行多因素分析以探讨影响患者预后的因素。
21例患者中，10例（47.6%）ACC实体瘤组织含量小于30%，其1年、3年和5年总生存率分别为100%、100%和70%；11例（52.4%）实体瘤组织含量不少于30%，其1年、3年和5年总生存率分别为70%、40%和10%，两组差异有统计学意义（P=0.02）。Log-rank检验及协变量变量模型曲线生存分析显示病理分类对患者预后有显著影响。T3期患者预后略好于T4期患者；起源于上颌窦的肿瘤预后略好于起源于蝶窦的肿瘤。手术联合放疗患者的治疗效果优于单纯手术或单纯放疗。多因素Cox回归模型分析显示，病理分类（P=0.045）和病程（P=0.028）与患者预后密切相关。
鼻腔及鼻窦ACC发病率低，无特异性症状，早期诊断困难，多数患者确诊时已处于晚期。建议对这类患者采用手术、术后放疗及化疗相结合的综合治疗。病理分类、病程、病变部位、临床分期、治疗方法、周围神经受累情况、切缘状态及术后放疗剂量均可能是影响晚期ACC患者预后的因素。
