Wei W, Liu J Q, Qi Y, Li X M, Meng F Y, Ren Q Z, Yan B, Wang Z L, Zhang Q H
Department of Otorhinolaryngology Head and Neck Surgery, XuanWu Hospital, Capital Medical University, Beijing 100053, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 May 7;58(5):438-444. doi: 10.3760/cma.j.cn115330-20221107-00666.
To evaluate the efficacy of endoscopic transnasal surgery for sinonasal and skull base adenoid cystic carcinoma (ACC), and to analyze the prognostic factors. Data of 82 patients (43 females and 39 males, at a median age of 49 years old) with sinonasal and skull base ACC who were admitted to XuanWu Hospital, Capital Medical University between June 2007 and June 2021 were analyzed retrospectively. The patients were staged according to American Joint Committee on Cancer (AJCC) 8th edition. The disease overall survival(OS) and disease-free survival(DFS) rates were calculated by Kaplan-Meier analysis. Cox regression model was used for multivariate prognostic analysis. There were 4 patients with stage Ⅱ, 14 patients with stage Ⅲ, and 64 patients with stage Ⅳ. The treatment strategies included purely endoscopic surgery (=42), endoscopic surgery plus radiotherapy (=32) and endoscopic surgery plus radiochemotherapy (=8). Followed up for 8 to 177 months, the 5-year OS and DFS rates was 63.0% and 51.6%, respectively. The 10-year OS and DFS rates was 51.2% and 31.8%, respectively. The multivariate Cox regression analysis showed that late T stage and internal carotid artery (ICA) involvement were the independent prognostic factors for survival in sinonasal and skull base ACC (all <0.05). The OS of patients who received surgery or surgery plus radiotherapy was significantly higher than that of patients who received surgery plus radiochemotherapy (all <0.05). Endoscopic transonasal surgery or combing with radiotherapy is an effective procedure for the treatment of sinonasal and skull base ACC. Late T stage and ICA involvement indicate poor prognosis.
评估鼻内镜经鼻手术治疗鼻窦及颅底腺样囊性癌（ACC）的疗效，并分析预后因素。回顾性分析2007年6月至2021年6月首都医科大学宣武医院收治的82例鼻窦及颅底ACC患者（43例女性，39例男性，中位年龄49岁）的数据。患者根据美国癌症联合委员会（AJCC）第8版进行分期。采用Kaplan-Meier分析计算疾病总生存率（OS）和无病生存率（DFS）。采用Cox回归模型进行多因素预后分析。Ⅱ期患者4例，Ⅲ期患者14例，Ⅳ期患者64例。治疗策略包括单纯内镜手术（=42例）、内镜手术加放疗（=32例）和内镜手术加放化疗（=8例）。随访8至177个月，5年OS率和DFS率分别为63.0%和51.6%。10年OS率和DFS率分别为51.2%和31.8%。多因素Cox回归分析显示，T分期较晚和颈内动脉（ICA）受累是鼻窦及颅底ACC生存的独立预后因素（均<0.05）。接受手术或手术加放疗患者的OS显著高于接受手术加放化疗的患者（均<0.05）。鼻内镜经鼻手术或联合放疗是治疗鼻窦及颅底ACC的有效方法。T分期较晚和ICA受累提示预后不良。
