Ziai Hedyeh, Yu Eugene, Weinreb Ilan, Perez-Ordonez Bayardo, Yao Christopher M K L, Xu Wei, Yang Dongyang, Witterick Ian J, Monteiro Eric, Gilbert Ralph W, Irish Jonathan C, Gullane Patrick J, Goldstein David P, Ringash Jolie, Bayley Andrew, de Almeida John R
Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
J Neurol Surg B Skull Base. 2020 Oct 5;82(6):608-614. doi: 10.1055/s-0040-1715809. eCollection 2021 Dec.
The aim of this study is to determine if Hyams grade may help predict which patients with esthesioneuroblastoma (ENB) tumors are likely to develop regional recurrences, and to determine the impact of tumor extent on regional failure in ENB patients without evidence of nodal disease at presentation. The study was designed as a retrospective review for ENB patients. The study was prepared at tertiary care academic center for ENB patients. Patients with ENB were included in the study. Oncologic outcomes (5-year regional and locoregional control (LRC) and overall survival) in patients with Hyams low grade versus high grade. Oncologic outcomes based on radiographic disease extent. A total of 43 patients were included. Total 25 patients (58%) had Hyams low-grade tumor, and 18 (42%) had high-grade tumor. Of the 34 patients without regional disease at presentation, 8 (24%) were treated with elective nodal radiation. There were no statistically significant differences in 5-year regional control in the Hyams low-grade versus high-grade groups (78 vs. 89%; = 0.4). The 5-year LRC rates in patients with low grade versus high grade were 73 versus 89% ( = 0.6). The 5-year overall survival rates in patients with low-grade versus high-grade tumors were 86 versus 63% ( = 0.1). Radiographic extension of disease into the olfactory groove, olfactory nerve, dura, and periorbita were statistically associated with decreased 5-year overall survival (5-year OS 49 vs. 91% [ = 0.04], 49 vs. 91% [ = 0.04], 44 vs. 92% [ = 0.02], and 44 vs. 80% [ = 0.04], respectively). ENBs are associated with a risk of regional failure. The current analysis suggests that Hyams low-grade and high-grade malignancies have comparable rates of early and delayed regional recurrences, although small sample size may limit our conclusions.
本研究的目的是确定海姆斯分级是否有助于预测哪些嗅神经母细胞瘤（ENB）患者可能发生局部复发，并确定肿瘤范围对初诊时无淋巴结疾病证据的ENB患者局部失败的影响。本研究设计为对ENB患者的回顾性分析。该研究在一家三级医疗学术中心针对ENB患者开展。患有ENB的患者被纳入研究。比较海姆斯低级别与高级别患者的肿瘤学结局（5年局部和区域局部控制（LRC）及总生存率）。基于影像学疾病范围的肿瘤学结局。共纳入43例患者。总计25例患者（58%）患有海姆斯低级别肿瘤，18例（42%）患有高级别肿瘤。在初诊时无局部疾病的34例患者中，8例（24%）接受了选择性淋巴结放疗。海姆斯低级别组与高级别组的5年局部控制率无统计学显著差异（78%对89%；P = 0.4）。低级别与高级别患者的5年LRC率分别为73%和89%（P = 0.6）。低级别与高级别肿瘤患者的5年总生存率分别为86%和63%（P = 0.1）。疾病影像学扩展至嗅沟、嗅神经、硬脑膜和眶周与5年总生存率降低具有统计学相关性（5年总生存率分别为49%对91% [P = 0.04]，49%对91% [P = 0.04]，44%对92% [P = 0.02]，以及44%对80% [P = 0.04]）。ENB与局部失败风险相关。目前的分析表明，尽管样本量较小可能会限制我们的结论，但海姆斯低级别和高级别恶性肿瘤的早期和延迟局部复发率相当。
