接受放化疗后的鼻窦鳞状细胞癌患者的治疗失败模式。

Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China.

Department of Oncology, 920th Hospital of Joint Logistics Support Force, Kunming 650032, China.

Br J Radiol. 2024 Nov 1;97(1163):1870-1878. doi: 10.1093/bjr/tqae175.

OBJECTIVES

To investigate the failure patterns based on precision radiation treatment and to determine the predictive factors of treatment failure for sinonasal squamous cell carcinoma (SNSCC) patients.

METHODS

This was a retrospective study that included 214 cases of treatment failure from 441 consecutive patients. Two experienced radiation oncologists evaluated the tumour volume of cases with local recurrence. The 5-year overall survival (OS), progression-free survival (PFS) rates, and distant-metastasis-free survival (DMFS) were estimated. Investigations were performed on the factors that predicted local failure or distant metastasis.

RESULTS

About 140 (31.7%) patients developed local recurrence, 24 (5.4%) experienced regional failure, and 65 (14.7%) underwent distant metastasis. In-field, marginal, and out-of-field failures occurred in 55.7% (78/140), 33.6% (47/140), and 10.7% (15/140) of patients with local recurrence, respectively. In logistic regression analysis, factors statistically significant for total local failure included treatment mode (P < .01), chemotherapy (P < .01), and surgical margins (P < .01). Primary tumours with poor differentiation (P = .018) and R2 resection margin (P = .009) were more prone to develop distant failure. The 5-year OS, PFS, and DMFS rates were 57.8%, 52.0%, and 56.7% for the whole cohort. In univariate and multivariate analysis, the skull base involvement was an independent predictor for poorer OS and PFS; orbital invasion was an independent predictor for poorer OS.

CONCLUSIONS

Local recurrence and distant metastasis were the most common failure modes. Treatment mode, chemotherapy, and surgical margins were related to local recurrence. Poor differentiation and R2 resection margin were predictors for distant failure.

ADVANCES IN KNOWLEDGE

Local recurrence is the most common failure pattern in patients with SNSCC who accepted chemoradiotherapy, and marginal and out-of-field failures occurred in 44.3% of patients with local recurrence.

目的

基于精确放疗探讨失败模式，并确定影响鼻窦鳞状细胞癌（SNSCC）患者治疗失败的预测因素。

方法

本研究为回顾性研究，纳入 441 例连续患者中的 214 例治疗失败病例。由 2 名经验丰富的放射肿瘤学家评估局部复发病例的肿瘤体积。估计 5 年总生存率（OS）、无进展生存率（PFS）和无远处转移生存率（DMFS）。分析预测局部失败或远处转移的因素。

结果

约 140 例（31.7%）患者发生局部复发，24 例（5.4%）发生区域失败，65 例（14.7%）发生远处转移。局部复发患者中，78/140（55.7%）、47/140（33.6%）和 15/140（10.7%）分别出现靶区内、靶区边缘和靶区外失败。多因素逻辑回归分析显示，总局部失败的统计学显著相关因素包括治疗模式（P<.01）、化疗（P<.01）和手术切缘（P<.01）。分化差的原发肿瘤（P=.018）和 R2 切除边界（P=.009）更易发生远处失败。全队列的 5 年 OS、PFS 和 DMFS 率分别为 57.8%、52.0%和 56.7%。单因素和多因素分析显示，颅底侵犯是 OS 和 PFS 较差的独立预测因素；眼眶侵犯是 OS 较差的独立预测因素。