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(ACC)的临床特征，探讨切缘病检结果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ACC患者的临床资料、治疗方法及预后。其中T3和T4期病变患者各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患者最长生存达32年。结论晚期鼻腔鼻窦ACC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:

ObjectiveTo summarize the clinical features of advanced sinonasal adenoid cystic carcinoma(ACC), and to explore the relationship between surgical margin, recurrence or metastasis and prognosis.MethodsThe clinical data, treatment and prognosis of 12 patients with advanced sinonasal ACC were analyzed retrospectively. Among them, all of 6 patients with T3 and 6 patients with T4 were not local lymph node and systemic metastases. All patients underwent surgery as initial treatment, 9 cases combined with postoperative radiotherapy and 4 cases combined with chemotherapy. The treatment of them were various when local recurrence or distant metastasis.ResultsThe positive rate of surgical margin was high (75%, 15/20) in 20 cases of initial and recurrent lesions. And those with positive surgical margins were surviving up to 32 years.During the follow-up period, there were 7 cases of local recurrence (2 cases with distant metastasis) and 1 case of simple distant metastasis. The longest survival of patients with local recurrence and distant metastasis was 32 years.ConclusionAdvanced sinonasal ACC has a high positive surgical margin rate and a high local recurrence rate. However, the patients 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.