Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Department of Otorhinolaryngology - Head and Neck Surgery, 2013Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York, USA.
Am J Rhinol Allergy. 2022 Sep;36(5):591-598. doi: 10.1177/19458924221092529. Epub 2022 Apr 19.
While extramedullary plasmacytomas are infrequently encountered plasma cell malignancies, most cases occur in the head and neck, with a predilection for the sinonasal cavity. Due to the rarity of this disease, the majority of studies on sinonasal extramedullary plasmacytoma (SN-EMP) are case reports or small retrospective case series.
To investigate the impact of patient, disease, and treatment factors on the survival of patients with SN-EMP.
The National Cancer Database was queried for all patients with SN-EMP between 2004-2016 (N = 381 cases). Univariate and multivariate analyses were used to examine patient demographics, tumor characteristics, and survival.
The majority of SN-EMP patients were over 60 years old (57.0%), male (69.8%), and white (86.2%). The most common treatment modality was radiotherapy alone (38.6%), followed by surgery plus radiotherapy (37.8%). Five-year overall survival was 74.0% and median survival was 9.1 years. Accounting for patient demographics and tumor characteristics in a multivariate model, the following groups had worse prognosis: 60 and older (HR 1.99, p = 0.031) and frontal sinus primary site (HR 11.56, p = 0.001). Patients who received no treatment (HR 3.89, p = 0.013), chemotherapy alone (HR 5.57, p = 0.008) or radiotherapy plus chemotherapy (HR 2.82, p = 0.005) had significantly lower survival than patients who received radiotherapy alone. Patients who received surgery with radiotherapy (HR 0.57, p = 0.039) had significantly higher survival than patients who received radiotherapy alone.
In patients with SN-EMP five-year overall survival was found to be 74.0% with decreased survival associated with a frontal sinus primary site and being aged 60 or older. Patients receiving no treatment, chemotherapy alone, or radiotherapy with chemotherapy was associated with lower survival. Receiving surgery plus radiotherapy was associated with the highest five-year overall survival.
虽然髓外浆细胞瘤是一种罕见的浆细胞恶性肿瘤，但大多数病例发生在头颈部，鼻窦腔是其好发部位。由于该病的罕见性，大多数关于鼻窦髓外浆细胞瘤（SN-EMP）的研究都是病例报告或小回顾性病例系列。
探讨患者、疾病和治疗因素对 SN-EMP 患者生存的影响。
2004 年至 2016 年间，国家癌症数据库中检索所有 SN-EMP 患者（N=381 例）。使用单变量和多变量分析来检查患者的人口统计学、肿瘤特征和生存情况。
大多数 SN-EMP 患者年龄在 60 岁以上（57.0%），男性（69.8%），白人（86.2%）。最常见的治疗方式是单纯放疗（38.6%），其次是手术加放疗（37.8%）。5 年总生存率为 74.0%，中位生存时间为 9.1 年。在多变量模型中考虑患者人口统计学和肿瘤特征后，以下组的预后较差：60 岁及以上（HR 1.99，p=0.031）和额窦原发部位（HR 11.56，p=0.001）。未治疗（HR 3.89，p=0.013）、单纯化疗（HR 5.57，p=0.008）或放化疗（HR 2.82，p=0.005）的患者生存率明显低于单纯放疗的患者。接受手术加放疗的患者（HR 0.57，p=0.039）的生存率明显高于单纯放疗的患者。
在 SN-EMP 患者中，5 年总生存率为 74.0%，生存率降低与额窦原发部位和 60 岁或以上年龄有关。未治疗、单纯化疗或放化疗的患者生存率较低。接受手术加放疗的患者 5 年总生存率最高。
