CAJ | 학술논문

目的探讨上颌窦腺样囊性癌的临床特点、治疗方法、预后以及影响预后的因素.方法回顾分析1975-2009年80例上颌窦腺样囊性癌的临床资料,采用Kaplan-Meier法、Log-rank检验和Cox回归检验模型进行生存分析和预后因素分析.结果总5、10、15年累积生存率和无瘤生存率分别为65.2%、37.1%、26.3%和50.7%、30.7%、24.5%.总5、10、15年累积局部控制率为68.5%、47.3%、47.3%,累积远处转移率为32.8%、48.8%、48.8%.T分期较晚和单一方法治疗对预后有显著影响(P值均<0.05).综合治疗的局部控制率高于单一治疗(χ2=18.33,P<0.01),且术后放疗效果好于术前放疗(χ2=6.64,P<0.05);术前放疗剂量≥60 Gy和放疗后手术切缘阴性的局部控制率好于放疗剂量<60 Gy和切缘阳性的患者(χ2=5.06,P<0.05).局部复发占患者死亡原因的62.8%.Cox多因素分析显示综合治疗显著提高了患者的生存率和局部控制率(P值均<0.05).结论局部复发是导致上颌窦腺样囊性癌治疗失败的主要原因.手术加放疗是最佳治疗方式,以术后放疗为首选方案.
목적 탐토상합두선양낭성암적림상특점、치료방법、예후이급영향예후적인소.방법 회고분석1975-2009년80례상합두선양낭성암적림상자료,채용Kaplan-Meier법、Log-rank검험화Cox회귀검험모형진행생존분석화예후인소분석.결과 총5、10、15년루적생존솔화무류생존솔분별위65.2%、37.1%、26.3%화50.7%、30.7%、24.5%.총5、10、15년루적국부공제솔위68.5%、47.3%、47.3%,루적원처전이솔위32.8%、48.8%、48.8%.T분기교만화단일방법치료대예후유현저영향(P치균<0.05).종합치료적국부공제솔고우단일치료(χ2=18.33,P<0.01),차술후방료효과호우술전방료(χ2=6.64,P<0.05);술전방료제량≥60 Gy화방료후수술절연음성적국부공제솔호우방료제량<60 Gy화절연양성적환자(χ2=5.06,P<0.05).국부복발점환자사망원인적62.8%.Cox다인소분석현시종합치료현저제고료환자적생존솔화국부공제솔(P치균<0.05).결론 국부복발시도치상합두선양낭성암치료실패적주요원인.수술가방료시최가치료방식,이술후방료위수선방안.
Objective To study the clinical characters, the outcomes of treatments and the factors affecting long-term treatment results of adenoid cystic carcinoma ( ACC) of the maxillary sinus. Methods The clinical data of 80 patients with ACC of the maxillary sinus treated initially were analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression. Results The 5-, 10- and 15-year cumulative overall survival rates were 65. 2% , 37. 1% , 26. 3% respectively and 5-, 10-, and 15-year disease-free survival rates 50.7% ,30.7% and 24.5% respectively. The 5-, 10- and 15-year cumulative local control rates were 68. 5% ,47. 3% and 47. 3% respectively and the cumulative distant metastasis rate were 32. 8% , 48. 8% and 48.8% respectively. Prognostic factors affecting survival included T stage, pathologic grade and the modes of treatment ( P < 0. 05). Patients with combined therapy composed of surgery and radiation had a better local control, compared with surgery or radiation alone ( χ2 = 18. 33, P < 0. 01 ), and surgery combined with postoperative radiation was prior to preoperative radiation combined with surgery ( χ2 = 6. 64 ,P < 0. 05). Patients treated with surgery combined with preoperative radiation, either with doses of ≥60 Cy or with negative margins, had a better local control, compared with doses < 60 Gy and with positive margins ( χ2 = 5. 06, P < 0.05 ) . The most of patients ( 62. 8% ) died of local recurrence. Conclusions The most of failure was due to recurrence. Combined therapy composed of surgery and radiation improves the local control and survival in patients with ACC of the maxillary sinus, compared with surgery or radiation alone. Surgery combined with postoperative radiation provides the best overall survival and local control and should be the first choice of treatments.