CAJ | 학술논문

目的：探讨鼻腔鼻窦恶性内翻性乳头状瘤的治疗及预后。方法回顾性分析1974年1月至2012年2月间治疗的62例鼻腔鼻窦恶性内翻性乳头状瘤患者的临床和随访资料。62例患者均为鳞癌，其中Ⅰ～Ⅱ期10例，Ⅲ期24例，Ⅳ期28例。单纯手术治疗26例，综合治疗36例。生存分析采用Kaplan?Meier和Log rank法，多因素分析采用Cox比例风险模型。结果全组患者的5年生存率为39．6％，其中Ⅰ～Ⅱ期患者的5年生存率为67．5％，Ⅲ期患者的5年生存率为51．3％，Ⅳ期患者的5年生存率为18．3％，差异有统计学意义（P＜0．05）。恶变前有手术史和无手术史患者的5年生存率分别为29．9％和65．7％，差异有统计学意义（P＜0．05）。有术后复发患者和无术后复发患者的5年生存率分别为17．6％和49．6％，差异有统计学意义（P＜0．05）。Ⅲ～Ⅳ期患者中，单纯手术患者的5年生存率为32．4％，综合治疗患者为36．2％，差异无统计学意义（P＝0．89）。单因素分析显示，临床分期、恶变前手术史、颅底和（或）眶内容物侵犯情况和术后复发情况与鼻腔鼻窦恶性内翻性乳头状瘤患者的预后有关（均P＜0．05）。多因素分析显示，患者年龄、临床分期和恶变前手术史为影响鼻腔鼻窦恶性内翻性乳头状瘤患者预后的独立因素。远处转移是重要的死亡原因，其中肺部转移最多见。结论影响鼻腔鼻窦恶性内翻性乳头状瘤患者预后的主要因素为患者年龄、临床分期、恶变前手术史，远处转移是鼻腔鼻窦恶性内翻性乳头状瘤患者死亡的主要因素。
목적：탐토비강비두악성내번성유두상류적치료급예후。방법회고성분석1974년1월지2012년2월간치료적62례비강비두악성내번성유두상류환자적림상화수방자료。62례환자균위린암，기중Ⅰ～Ⅱ기10례，Ⅲ기24례，Ⅳ기28례。단순수술치료26례，종합치료36례。생존분석채용Kaplan?Meier화Log rank법，다인소분석채용Cox비례풍험모형。결과전조환자적5년생존솔위39．6％，기중Ⅰ～Ⅱ기환자적5년생존솔위67．5％，Ⅲ기환자적5년생존솔위51．3％，Ⅳ기환자적5년생존솔위18．3％，차이유통계학의의（P＜0．05）。악변전유수술사화무수술사환자적5년생존솔분별위29．9％화65．7％，차이유통계학의의（P＜0．05）。유술후복발환자화무술후복발환자적5년생존솔분별위17．6％화49．6％，차이유통계학의의（P＜0．05）。Ⅲ～Ⅳ기환자중，단순수술환자적5년생존솔위32．4％，종합치료환자위36．2％，차이무통계학의의（P＝0．89）。단인소분석현시，림상분기、악변전수술사、로저화（혹）광내용물침범정황화술후복발정황여비강비두악성내번성유두상류환자적예후유관（균P＜0．05）。다인소분석현시，환자년령、림상분기화악변전수술사위영향비강비두악성내번성유두상류환자예후적독립인소。원처전이시중요적사망원인，기중폐부전이최다견。결론영향비강비두악성내번성유두상류환자예후적주요인소위환자년령、림상분기、악변전수술사，원처전이시비강비두악성내번성유두상류환자사망적주요인소。
Objective To analyze the factors affecting prognosis of the carcinoma arising from nasal and sinonasal inverted papilloma. Methods The clinicopathological data of sixty?two patients treated in our hospital from January 1974 to February 2012 were retrospectively analyzed. Of the 62 cases, 10 were at stageⅠ or Ⅱ, 24 at stage Ⅲ, and 28 at stage Ⅳ. Twenty?six patients were treated with surgery alone, and 36 with surgery combined with radiation therapy. Kaplan?Meier method and log?rank test were used for the survival analysis. Results The overall 5?years survival rate was 39. 6%. The 5?years survival rate was 67. 5% in the stage Ⅰ orⅡpatients,51. 3% in the stageⅢpatients, and 18. 3% in the stageⅣpatients (P<0. 05). The 5?years survival rate was 65. 7% in patients who had no surgical history, and 29. 9% in patients who had surgery (P<0. 05). The 5?year survival rate was 17. 6% in the group who relapsed after the treatment, and 49. 6% in the non?relapsed patients (P<0. 05). The 5?year survival rate was 23. 4% in the patients who had involvement of cranial base and (or ) orbit, and 47. 6% in the patients whose cranial base and (or ) orbit were clean (P<0. 05). Of the patients at the same stage (Ⅲ?Ⅳ), the 5?year survival rate of patients treated with surgery alone was 32. 4%, and those treated with combination therapy was 36. 2%(P=0. 89). The univariate analysis showed that clinical stage, surgical history before malignization, involvement of the cranial base and ( or) orbit organs, and post?operative relapse are significantly correlated to prognosis of the patients (P<0. 05 for all). Multivariate analysis showed that age, clinical stage, and previous history of surgery were independent factors affecting the prognosis of the patients. Distant metastasis was the major cause of death, mostly lung metastases. Conclusions Age, clinical stage and surgical history are the main factors affecting the prognosis of the patients. The history of recurrence and involvement of cranial base or orbit also play an important role for the prognosis. Distant metastasis is the main cause of death in the patients with carcinoma arising from nasal and sinonasal inverted papilloma.