Department of ORL - Head and Neck Surgery, Regional University Hospital of Nancy, Hospital of Brabois, Nancy, France.
Faculty of Medicine, University of Lorraine, Vandœuvre-lès-Nancy, France.
Head Neck. 2018 Nov;40(11):2389-2398. doi: 10.1002/hed.25349. Epub 2018 Jun 26.
The purpose of this study was to describe the pathology of the different compartments in endoscopic resection of nasal intestinal-type adenocarcinomas (ITACs) and its relationships with oncologic outcomes.
This retrospective study included all patients endoscopically operated for nasal ITACs, followed by radiotherapy in the majority of cases, between 2004 and 2014. The surgery systematically separated 3 compartments: ethmoid lateral mass, olfactory cleft, and anterior cranial fossa (in cases with skull-base invasion) to analyze their pathological "focal" or "massive" invasion by the tumor.
Sixty-seven patients (aged 69.2 ± 9.8 years) were included. Twenty-nine patients (43.3%) had only pathological focal invasion. At 61.0 ± 41.7 months of mean follow-up, the recurrence rates were 34.2% in the group with massive invasion and 10.3% in the group with focal invasion (P = .023). The disease-specific death rate had a tendency to be higher in the group with massive invasion (23.7% vs 6.9% for the group with focal invasion; P = .097). By Kaplan-Meier analysis, the 5-year disease-specific survival rate was better in the group with focal invasion than the group with massive invasion (P = .01). The 5-year overall survival was not different between the 2 groups (47.4% and 65.5% for focal invasion and massive invasion respectively; P = .14).
Compartmentalized endoscopic resection, combined with postoperative radiotherapy, is one way to operate on nasal ITACs with good oncologic outcomes.
本研究旨在描述内镜切除鼻肠型肠内型腺癌（ITACs）不同部位的病理学特征及其与肿瘤学结果的关系。
本回顾性研究纳入了 2004 年至 2014 年间接受内镜手术治疗、多数病例辅以放疗的鼻 ITAC 患者。手术系统地分离了 3 个部位：筛骨外侧壁、嗅裂和前颅窝（有颅底侵犯的病例），以分析肿瘤对这些部位的“局灶性”或“弥漫性”侵犯。
共纳入 67 例患者（年龄 69.2±9.8 岁）。29 例（43.3%）仅存在局灶性病理学侵犯。在平均 61.0±41.7 个月的随访中，弥漫性侵犯组的复发率为 34.2%，局灶性侵犯组为 10.3%（P=0.023）。弥漫性侵犯组的疾病特异性死亡率有增高趋势（23.7%比局灶性侵犯组的 6.9%；P=0.097）。Kaplan-Meier 分析显示，局灶性侵犯组的 5 年疾病特异性生存率优于弥漫性侵犯组（P=0.01）。两组的 5 年总生存率无差异（局灶性侵犯组为 47.4%，弥漫性侵犯组为 65.5%；P=0.14）。
结合术后放疗的内镜分区切除术是治疗鼻 ITAC 的一种有效方法，可获得良好的肿瘤学结果。
