【摘要】：目的:分析中國(guó)人群中嗅神經(jīng)母細(xì)胞瘤(esthesioneuroblastoma,ENB)的治療療效及預(yù)后因素。方法:以"嗅神經(jīng)母細(xì)胞瘤"為關(guān)鍵字在CNKI和萬方數(shù)據(jù)庫(kù)中進(jìn)行檢索,檢索時(shí)限為1981-2015年。從病例報(bào)道和病例分析研究中共收集187例ENB病例,全部按Kadish分期標(biāo)準(zhǔn)進(jìn)行分期,Kaplan-Meier法計(jì)算生存率。結(jié)果:研究共納入187位ENB患者,中位隨訪時(shí)間為24個(gè)月(1~204個(gè)月),患者的2年總生存率(overall survival,OS)為75.4%,2年無病生存率(disease-free survival,DFS)為52.9%。Kadish臨床分期A期、B期、C期患者的2年OS分別為92%、96%、62.5%(χ2=21.724,P=0.000),2年DFS分別為72%、66%、42.9%(χ2=14.874,P=0.000)。以手術(shù)聯(lián)合放療為主的綜合治療模式和其他治療模式(包括單純放療、單純手術(shù)、放療+化療、姑息治療)的2年OS分別為84.5%和60.6%(χ2=15.283,P=0.000),2年DFS分別為63.8%和35.2%(χ2=15.907,P=0.003)。有頸部淋巴結(jié)轉(zhuǎn)移(N+)和無頸部淋巴結(jié)轉(zhuǎn)移(N0)的2年OS分別為53.1%和80%(χ2=12.614,P=0.000),2年DFS分別為34.4%和56.8%(χ2=8.722,P=0.003)。復(fù)發(fā)是治療失敗的主要模式,其中以遠(yuǎn)處轉(zhuǎn)移預(yù)后最差。在187例患者中共有64例患者出現(xiàn)復(fù)發(fā),復(fù)發(fā)率為34.2%,其中C期49例(43.8%),增加化療并不能減少C期患者的復(fù)發(fā)率,但頸部淋巴結(jié)清掃能減少N+患者的復(fù)發(fā)率。結(jié)論:手術(shù)聯(lián)合放療為主的綜合治療仍是目前ENB最佳的治療模式,影響生存的主要因素為Kadish分期、治療方式、復(fù)發(fā)和淋巴結(jié)情況,化療的影響仍需進(jìn)一步深入研究。
[Abstract]:Objective: to analyze the therapeutic effect and prognostic factors of olfactory neuroblastoma (esthesioneuroblastoma,ENB) in Chinese population. Methods: using "olfactory neuroblastoma" as the key word, the search time was 1981-2015 in CNKI and Wanfang database. A total of 187 cases of ENB were collected from case report and case analysis. All of them were staging according to Kadish staging criteria. Survival rate was calculated by Kaplan-Meier method. Results: the median follow-up time was 24 months (1-204 months), the overall 2-year survival rate (overall survival,OS) was 75.4, the 2-year disease-free survival rate (disease-free survival,DFS) was 52.9%.Kadish clinical stage A, stage B, stage C, the 2-year OS was 62.5% (蠂 221.724 P 0.000), and the 2-year DFS was 72.2% (蠂 214.874P 0.000). The 2-year OS of combined operation combined with radiotherapy was 84.5% and 60.6% respectively (蠂 2 15.283 P 0.000) and DFS of 2 years was 63.8% and 35.2% respectively (蠂 2 15.907 P 0.003). The OS of 2 years with cervical lymph node metastasis (N) and without cervical lymph node metastasis (N0) were 53.1% and 80%, respectively (蠂 2, 12.614%, 0.000), and the 2-year DFS were 34.4% and 56.8%, respectively (蠂 2: 8.722 P, P 0. 003). Recurrence is the main mode of failure, and distant metastasis has the worst prognosis. The recurrence rate was 34.2in 64 out of 187 patients, 49 (43.8%) of whom were in stage C. increased chemotherapy could not reduce the recurrence rate of stage C, but neck lymph node dissection could reduce the recurrence rate of N patients. Conclusion: combined surgery combined with radiotherapy is still the best treatment mode for ENB at present. The main factors affecting survival are Kadish stage, treatment mode, recurrence and lymph node status. The effect of chemotherapy needs further study.
【作者單位】： 南昌大學(xué)第二附屬醫(yī)院腫瘤科;
【基金】：國(guó)家自然科學(xué)基金資助項(xiàng)目(編號(hào):81560509)
【分類號(hào)】：R739.4
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本文編號(hào)：2285603