不同组织学亚型的原发性鼻咽腺癌患者的长期预后：单中心 71 例经验。

Long-term outcomes of patients in different histological subtypes of primary nasopharyngeal adenocarcinoma: A single-center experience with 71 cases.

机构信息

Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

出版信息

Oral Oncol. 2020 Dec;111:104923. doi: 10.1016/j.oraloncology.2020.104923. Epub 2020 Aug 11.

DOI:10.1016/j.oraloncology.2020.104923

PMID:32795912

Abstract

OBJECTIVE

This study is aimed to evaluate the long-term outcomes and management approaches in different histological subtypes of primary nasopharyngeal adenocarcinoma (NPAC).

MATERIALS AND METHODS

71 patients with NPAC at our institution between 1984 and 2016 were reviewed, including adenoid cystic carcinoma (ACC) in 43 patients, mucoepidermoid carcinoma (MEC) in 17 patients, and primary traditional adenocarcinoma (AC) in 11 patients. 37 patients received primary radiotherapy and 34 patients underwent primary surgery.

RESULTS

The median time of follow-up was 77 months. The 5-year overall survival rate (OS), locoregional failure-free survival rate (LRFFS) and distant metastasis failure-free survival rate (DFFS) were 69.9%, 67.1% and 77.9%, respectively. Patients who received combined modality therapy had better 5-year OS (73.7% vs 66.2%, p = 0.065) and LRFFS (73.1% vs 64.5%, p = 0.047) than patients receiving single modality therapy. Regarding the different histological subtypes, the survival rates of patients with ACC undergoing primary radiotherapy and primary surgery were similar (5-year OS 82.3% vs 68.8%, LRFFS 70.0% vs 70.8%, p＞0.05). As to patients with MEC and AC, those who underwent primary surgery achieved better 5-year OS (75.6% vs 45.5%, p = 0.001) and LRFFS (70.6%% vs 57.1%, p = 0.014) than those who received primary radiotherapy. Multivariate analyses indicated that histological subtypes and radiotherapy technique were independent factors for OS.

CONCLUSIONS

The optimal treatment policy for NPAC remained the combination of radiotherapy and surgery. For patients with ACC, radiotherapy could be considered as the primary treatment. Surgery was suggested to be the primary treatment in patients with MEC and AC.

摘要

目的

本研究旨在评估不同组织学亚型的原发性鼻咽腺癌（NPAC）的长期疗效和治疗方法。

材料和方法

回顾了 1984 年至 2016 年我院收治的 71 例 NPAC 患者，包括腺样囊性癌（ACC）43 例、黏液表皮样癌（MEC）17 例、原发性传统腺癌（AC）11 例。37 例患者接受了单纯放疗，34 例患者接受了单纯手术治疗。

结果

中位随访时间为 77 个月。5 年总生存率（OS）、无局部区域失败生存率（LRFFS）和无远处转移失败生存率（DFFS）分别为 69.9%、67.1%和 77.9%。接受联合治疗的患者 5 年 OS（73.7%比 66.2%，p=0.065）和 LRFFS（73.1%比 64.5%，p=0.047）均优于单纯治疗组。对于不同的组织学亚型，接受单纯放疗和单纯手术治疗的 ACC 患者的生存率相似（5 年 OS 82.3%比 68.8%，LRFFS 70.0%比 70.8%，p＞0.05）。而对于 MEC 和 AC 患者，接受手术治疗的患者 5 年 OS（75.6%比 45.5%，p=0.001）和 LRFFS（70.6%比 57.1%，p=0.014）均优于单纯放疗组。多因素分析表明，组织学类型和放疗技术是 OS 的独立影响因素。