Kraft Daniel O, Carey Ryan M, Prasad Aman, Rajasekaran Karthik, Kohanski Michael A, Kennedy David W, Palmer James N, Adappa Nithin D, Newman Jason G, Brant Jason A
Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
J Neurol Surg B Skull Base. 2021 Jun 10;83(Suppl 2):e459-e466. doi: 10.1055/s-0041-1731031. eCollection 2022 Jun.
This study aimed to provide information regarding the prognosis of patients presenting with metastatic anterior skull base malignancies based upon histology and site of distant metastasis (DM). The National Cancer Database was queried for patients with anterior skull base malignant neoplasms with DM. Prognosis was compared between site of DM and tumor histologies. A multivariable Cox proportional hazards model was used to identify prognostic factors for overall survival (OS). A total of 481 patients were identified. Lung was the most common site of DM (24.9%), followed by bone (22.2%), liver (5.6%), and brain (2.5%). Lung was the most common site for squamous cell carcinoma (SCCa) (28.3%), melanoma (37.7%), and adenoid cystic carcinoma (ACC; 31.4%). The median survival for patients presenting with metastatic disease regardless of tumor histology was 9.0 months (95% confidence interval [CI]: 8.2-10.3), and patients with metastasis to the liver had the best median survival at 15.5 months (95% CI: 10.5-25.6). The median survivals for the most common histologies, SCCa, melanoma, and ACC were 8.2 months (95% CI: 5.5-10.2), 10.5 months (95% CI: 8.7-14.1), and 15.0 months (95% CI: 11.1-61.1), respectively. Multivariable analysis demonstrated worse overall survival (OS) for older patients, higher Charlson-Deyo comorbidity scores, and tumors with higher grade and T stage. Compared with metastasis to bone, lung metastasis had better OS on multivariable analysis (hazard ratio [HR]: 0.70, 95% CI: 0.51-97). Adenoid cystic carcinoma had improved OS compared with SCCa (HR: 0.62, 95% CI: 0.39-99). Tumor histology, metastatic sites, and several disease factors affected prognosis in anterior skull base malignancies with DM.
本研究旨在根据组织学类型和远处转移（DM）部位，提供有关转移性前颅底恶性肿瘤患者预后的信息。在国家癌症数据库中查询患有伴有DM的前颅底恶性肿瘤的患者。比较了DM部位和肿瘤组织学类型之间的预后情况。使用多变量Cox比例风险模型来确定总生存期（OS）的预后因素。共识别出481例患者。肺是最常见的DM部位（24.9%），其次是骨（22.2%）、肝（5.6%）和脑（2.5%）。肺是鳞状细胞癌（SCCa）（28.3%）、黑色素瘤（37.7%）和腺样囊性癌（ACC；31.4%）最常见的转移部位。无论肿瘤组织学类型如何，出现转移性疾病的患者的中位生存期为9.0个月（95%置信区间[CI]：8.2 - 10.3），肝转移患者的中位生存期最佳，为15.5个月（95% CI：10.5 - 25.6）。最常见的组织学类型SCCa、黑色素瘤和ACC的中位生存期分别为8.2个月（95% CI：5.5 - 10.2）、10.5个月（95% CI：8.7 - 14.1）和15.0个月（95% CI：11.1 - 61.1）。多变量分析表明，老年患者、较高的Charlson - Deyo合并症评分以及高分级和高T分期的肿瘤患者的总生存期较差。与骨转移相比，多变量分析显示肺转移患者的总生存期较好（风险比[HR]：0.70，95% CI：0.51 - 97）。与SCCa相比，腺样囊性癌患者的总生存期有所改善（HR：0.62，95% CI：0.39 - 99）。肿瘤组织学类型、转移部位和一些疾病因素影响伴有DM的前颅底恶性肿瘤的预后。
