中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2013年
12期
1002-1005
,共4页
鼻窦肿瘤%乳头状瘤,内翻%癌,鳞状细胞
鼻竇腫瘤%乳頭狀瘤,內翻%癌,鱗狀細胞
비두종류%유두상류,내번%암,린상세포
Paranasal sinus neoplasms%Papilloma,inverted%Carcinoma,squamous cell
目的 探讨伴有恶变的鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted papilloma,SNIP)的临床特征和组织病理学特征以及影响预后的因素.方法 回顾性分析1991年1月至2008年1月32例SNIP伴有恶变病例的临床特征以及组织病理学特征.包括年龄、性别、发病部位、临床分期、手术治疗方法、肿瘤分化程度和恶性细胞的比例.采用SPSS 17.0软件,应用Kaplan-Meier法,Log-rank单因素分析和Cox回归模型多因素分析法计算生存率和预后相关因素.结果 32例恶变的SNIP占同期SNIP的8.99％;其中男25例,女7例;中位发病年龄56.5岁;发病部位上颌窦10例,鼻腔及筛窦22例;肿瘤组织学分级为高分化21例,中分化8例,低分化3例;临床分期T1期3例,T2期10例,T3期16例,T4期3例.整个肿瘤组织中恶变区域的百分比:Ⅰ度5例,Ⅱ度5例,Ⅲ度8例,Ⅳ度14例.32例患者中3例远处转移.治疗方式包括单纯手术10例,单纯放疗3例,手术加放疗19例.总的5年生存率为72.5％,中位生存期62.2个月.经Kaplan-Meier法单因素分析显示,影响患者生存率的因素是临床分期和治疗方式(P值分别为0.002和0.030).经Cox回归模型多因素分析显示,影响患者生存率的独立危险因素是临床分期和治疗方式(风险比分别为4.211和0.312,P值均＜0.05).结论 SNIP恶变病例发病率低,临床表现无特异性.临床分期和治疗方式可影响SNIP恶变患者的预后.临床上外科手术切除联合术后放疗是其主要治疗手段.
目的 探討伴有噁變的鼻腔鼻竇內翻性乳頭狀瘤(sinonasal inverted papilloma,SNIP)的臨床特徵和組織病理學特徵以及影響預後的因素.方法 迴顧性分析1991年1月至2008年1月32例SNIP伴有噁變病例的臨床特徵以及組織病理學特徵.包括年齡、性彆、髮病部位、臨床分期、手術治療方法、腫瘤分化程度和噁性細胞的比例.採用SPSS 17.0軟件,應用Kaplan-Meier法,Log-rank單因素分析和Cox迴歸模型多因素分析法計算生存率和預後相關因素.結果 32例噁變的SNIP佔同期SNIP的8.99％;其中男25例,女7例;中位髮病年齡56.5歲;髮病部位上頜竇10例,鼻腔及篩竇22例;腫瘤組織學分級為高分化21例,中分化8例,低分化3例;臨床分期T1期3例,T2期10例,T3期16例,T4期3例.整箇腫瘤組織中噁變區域的百分比:Ⅰ度5例,Ⅱ度5例,Ⅲ度8例,Ⅳ度14例.32例患者中3例遠處轉移.治療方式包括單純手術10例,單純放療3例,手術加放療19例.總的5年生存率為72.5％,中位生存期62.2箇月.經Kaplan-Meier法單因素分析顯示,影響患者生存率的因素是臨床分期和治療方式(P值分彆為0.002和0.030).經Cox迴歸模型多因素分析顯示,影響患者生存率的獨立危險因素是臨床分期和治療方式(風險比分彆為4.211和0.312,P值均＜0.05).結論 SNIP噁變病例髮病率低,臨床錶現無特異性.臨床分期和治療方式可影響SNIP噁變患者的預後.臨床上外科手術切除聯閤術後放療是其主要治療手段.
목적 탐토반유악변적비강비두내번성유두상류(sinonasal inverted papilloma,SNIP)적림상특정화조직병이학특정이급영향예후적인소.방법 회고성분석1991년1월지2008년1월32례SNIP반유악변병례적림상특정이급조직병이학특정.포괄년령、성별、발병부위、림상분기、수술치료방법、종류분화정도화악성세포적비례.채용SPSS 17.0연건,응용Kaplan-Meier법,Log-rank단인소분석화Cox회귀모형다인소분석법계산생존솔화예후상관인소.결과 32례악변적SNIP점동기SNIP적8.99％;기중남25례,녀7례;중위발병년령56.5세;발병부위상합두10례,비강급사두22례;종류조직학분급위고분화21례,중분화8례,저분화3례;림상분기T1기3례,T2기10례,T3기16례,T4기3례.정개종류조직중악변구역적백분비:Ⅰ도5례,Ⅱ도5례,Ⅲ도8례,Ⅳ도14례.32례환자중3례원처전이.치료방식포괄단순수술10례,단순방료3례,수술가방료19례.총적5년생존솔위72.5％,중위생존기62.2개월.경Kaplan-Meier법단인소분석현시,영향환자생존솔적인소시림상분기화치료방식(P치분별위0.002화0.030).경Cox회귀모형다인소분석현시,영향환자생존솔적독립위험인소시림상분기화치료방식(풍험비분별위4.211화0.312,P치균＜0.05).결론 SNIP악변병례발병솔저,림상표현무특이성.림상분기화치료방식가영향SNIP악변환자적예후.림상상외과수술절제연합술후방료시기주요치료수단.
Objective To investigate the clinicopathological features and prognosis of patients with the malignant transformation of sinonasal inverted papilloma.Methods Thirty-two consecutive cases encounted between January 1991 and January 2008 were retrospectively reviewed.Survival rates and prognostic factors were caculated with SPSS 17.0 software using the Kaplan-Meier method and multivariate Cox model survival analysis.Results The malignancy accounted for 8.99％ of all types of sinonasal inverted papilloma.There were 25 males and 7 females,the median age was 56.5 years.The sites of tumor included 22 cases in nasal cavity and ethmoid sinuses,10 cases in maxillary sinuses.The tumors included 21 high grade tumors,8 intermediate grade tumors and 3 low grade tumors.Thirty-two patients were staged as T1 (3/32),T2(10/32),T3 (16/32),T4 (3/32).According to the percentage of the malignant cell in the entire tumor tissue,5 patients were in grade Ⅰ,5 patients were in grade Ⅱ,8 patients were in grade Ⅲ,14 patients were in grade Ⅳ.There were 3 distant metastasis in 32 patients; 19 patients underwent surgery plus postoperative radiotherapy,10 underwent surgery alone and 3 underwent radiotherapy alone.The 5-year overall survival were 72.5％,and the median overall survival time was 62.2 months.Kaplan-Meier univariate survival analysis indicated that the cilinical stages and treatment modalities were prognostic factors,and multivariate Cox model survival analysis confirmed that the cilinical stages and treatment modalities were independent factors for overall survival (HR were 4.211 and 0.312,all P ＜ 0.05).Conclusions The morbidity of sinonasal inverted papilloma-associated malignancy is low,the clinical features were not specificity.The cilinical stages and treatment modalities may affect the prognosis.Surgery plus postoperative radiotherapy are main treatment means.
