晚期鼻腔鼻窦腺样囊性癌12例临床分析

Advanced sinonasal adenoid cystic carcinoma：a clinical analysis of 12 cases

摘要:

目的 总结原发于鼻腔鼻窦的晚期腺样囊性癌的临床特征,探讨切缘以及复发或转移与预后的关系。方法 回顾性分析 12例晚期鼻腔鼻窦腺样囊性癌患者的临床资料、治疗方法及预后。其中T3和T4病变各6例,均无局部淋巴结及全身转移。首次治疗均以手术为主,9例联合术后放疗,4例联合化疗,复发及转移的治疗方式各异,仍以再手术为主。结果 在20次首发及复发病灶的手术中,切缘阳性率高(75%,15/20),切缘阳性者生存时间最长达32年；随访期间局部复发7例(2例合并远处转移),单纯远处转移1例,局部复发并远处转移生存最长达32年。结论 晚期鼻腔鼻窦腺样囊性癌手术切缘阳性率高,局部复发率高,但局部复发或远处转移后仍能带瘤生存较长时间,在行根治性手术以及复发或转移治疗决策时应充分考虑患者的生存质量。

Abstract:

Abstract: Objective To summarize the clinical features of advanced sinonasal adenoid cystic carcinoma, and to explore the relationship between surgical margin, recurrence or metastasis and prognosis . Methods The clinical data, treatment and prognosis of 12 cases of sinonasal adenoid cystic carcinoma were analyzed retrospectively. Among them, there were 6 cases of both T3 and T4 lesions, all without local lymph node and systemic metastases. All patients underwent surgery as initial treatment, and some with postoperative adjuvant radiotherapy (n=9), or adjuvant chemotherapy (n=4), the treatment were various when local recurrence or distant metastasis. Results Among the 20 surgeries for first and recurrent lesions, the rate of positive surgical margins was high (75%, 15/20), and those with positive surgical margins survived up to 32 years; 7 cases of local recurrence (2 combined with distant metastasis) and 1 case of distant metastasis alone during follow-up, and the longest survival of patients with local recurrence combined with distant metastasis was 32 years. Conclusion Advanced sinonasal adenoid cystic carcinoma has a high positive surgical margin rate and a high local recurrence rate, but it can still survive with tumor for a long time after local recurrence or distant metastasis, and the patient's survival quality should be fully considered when making decisions on radical surgery and treatment of recurrence or metastasis.