Joshi Rohan R, Husain Qasim, Roman Benjamin R, Cracchiolo Jennifer, Yu Yao, Tsai Jillian, Kang Julie, McBride Sean, Lee Nancy Y, Morris Luc, Ganly Ian, Tabar Viviane, Cohen Marc A
Department of Otolaryngology-Head & Neck Surgery, Columbia University Medical Center, New York, New York.
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York.
J Surg Oncol. 2019 Jan;119(1):130-142. doi: 10.1002/jso.25293. Epub 2018 Nov 22.
Esthesioneuroblastoma (ENB) is a rare neuroendocrine tumor. The purpose of this study was to compare the Kadish, tumor-node-metastasis (TNM), and Dulguerov's modified TNM staging in order to determine the impact of the stage on primary surgical treatment selection, margin status, and survival.
The National Cancer Database (NCDB) was used to identify patients diagnosed with ENB between 2004 to 2015. Patients were excluded based on the ability to properly stage their disease as well as the availability of treatment data.
Eight-hundred eighty-three patients had sufficient data for analysis. On multivariate analysis, age and government insurance were associated with primary surgical treatment, whereas tumor stage, gender, race, hospital type and volume, and comorbidity score were not. Age, charlson-deyo comorbidity (CDCC) score, hospital volume, and nodal status were found to be predictors of survival. Multivariate-analysis controlling for stage failed to demonstrate clear survival differences between staging in both TNM and Kadish systems. T-stage and the presence of regional nodal metastasis were associated with an increased risk of positive margins on multivariate analysis.
Although primary surgical management and positive margins can be predicted by certain patient and tumor factors, clinical staging systems for ENB poorly predict prognosis over a 10-year horizon.
嗅神经母细胞瘤（ENB）是一种罕见的神经内分泌肿瘤。本研究的目的是比较卡迪什（Kadish）分期、肿瘤-淋巴结-转移（TNM）分期和杜尔盖罗夫（Dulguerov）改良TNM分期，以确定分期对原发性手术治疗选择、切缘状态和生存率的影响。
利用国家癌症数据库（NCDB）确定2004年至2015年间诊断为ENB的患者。根据对疾病进行正确分期的能力以及治疗数据的可获得性排除患者。
883例患者有足够的数据进行分析。多因素分析显示，年龄和政府保险与原发性手术治疗相关，而肿瘤分期、性别、种族、医院类型和规模以及合并症评分则无关。年龄、查尔森-迪约合并症（CDCC）评分、医院规模和淋巴结状态是生存率的预测因素。在控制分期的多因素分析中，TNM和卡迪什系统分期之间未显示出明显的生存差异。多因素分析显示，T分期和区域淋巴结转移的存在与切缘阳性风险增加相关。
虽然原发性手术治疗和切缘阳性可通过某些患者和肿瘤因素预测，但ENB的临床分期系统在10年的时间跨度内对预后的预测较差。
