经鼻内镜手术治疗可疑颅内侵犯的鼻腔-筛窦癌：适应证、技术和结果。
Transnasal endoscopic surgery in selected nasal-ethmoidal cancer with suspected brain invasion: Indications, technique, and outcomes.
机构信息
Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
出版信息
Head Neck. 2019 Jun;41(6):1854-1862. doi: 10.1002/hed.25621. Epub 2019 Jan 12.
BACKGROUND
In nasal-ethmoidal malignancies, brain involvement is associated with dismal prognosis.
METHOD
Patients undergoing endoscopic resection with transnasal craniectomy and subpial dissection (ERTC-SD) for brain-invading nasal-ethmoidal cancer between 2008 and 2016 were included. Complications were analyzed in all patients, whereas oncological outcomes only in patients with pathological brain invasion. The prognostic impact of previous treatments, brain edema, and histology was assessed. Hospitalization ratio was calculated.
RESULTS
Nineteen patients received ERTC-SD and 11 had pathological-proven brain invasion. Histologies were 6 olfactory neuroblastomas (ONB), 3 neuroendocrine carcinomas, and 2 intestinal-type adenocarcinomas. Mean follow-up was 21.9 months. Three-year overall, local recurrence-free, and distance recurrence-free survivals were 65.5%, 81.8%, and 68.2%, respectively. Overall and distant recurrence-free survivals were significantly better in patients with ONB (P = 0.032 and P = 0.013, respectively). Hospitalization ratio was 4.1%. Complication rate was 10.5%.
CONCLUSION
In selected nasal-ethmoidal tumors with brain invasion, ERTC-SD can provide good local control, satisfactory survival, and limited morbidity.
背景
在鼻腔-筛窦恶性肿瘤中，脑侵犯与预后不良相关。
方法
纳入 2008 年至 2016 年间接受经鼻颅切开术和软脑膜下解剖内镜切除术（ERTC-SD）治疗脑侵犯鼻腔-筛窦癌的患者。对所有患者进行并发症分析，对有病理脑侵犯的患者仅进行肿瘤学结果分析。评估了既往治疗、脑水肿和组织学的预后影响。计算了住院比例。
结果
19 例患者接受了 ERTC-SD 治疗，11 例患者有病理证实的脑侵犯。组织学类型为 6 例嗅神经母细胞瘤（ONB）、3 例神经内分泌癌和 2 例肠型腺癌。平均随访时间为 21.9 个月。患者的 3 年总生存率、局部无复发生存率和远处无复发生存率分别为 65.5%、81.8%和 68.2%。ONB 患者的总生存率和远处无复发生存率显著更好（P=0.032 和 P=0.013）。住院比例为 4.1%。并发症发生率为 10.5%。
结论
在有脑侵犯的选择鼻腔-筛窦肿瘤中，ERTC-SD 可提供良好的局部控制、满意的生存和有限的发病率。
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