鼻-鼻窦鳞状细胞癌治疗后复发及挽救手术治疗

摘要

Objective To analyze the significant clinicopathologic factors related to tumor recurrence in patients with sinonasal squamous cell carcinomas (SCC) and to evaluate the effectiveness and plausibility of surgical salvage in the recurrent cases.Methods The clinicopatholgic data of 107 patients with primary sinonasal SCC treated from 1996 to 2007 were analyzed retrospectively.Univariate and multivariate logistic regression analyses were used to define the risk factors related to tumor recurrence.Salvage surgery with was selectively carried out in the recurrent sinonasal SCC using different surgical approaches,including lateral rhinotomy midfacial degloving or combined craniofacial approach.Immediate reconstruction of major surgical defects were performed with latissimus dorsi flap,pectoralis major myocutanneous flap,temperalis fasciomuscular flap,free rectus abdominis flap and free radial forearm flap.All patients were routinely follwed up and 5-year survival were calculated using directly calculating method and Kaplan-Meier's method.Results The 5-year survival rate of 107 cases was 52.3％ (56/107).Local recurrence was the most common pattern of tumor relapse.Forty-four of the 107 cases had recurrence.Logistic regression analysis showed the T stag was the most important impacting factor for tumor recurrence (OR =0.258,P =0.001).Of 44 cases with recurrence,33 cases underwent salvage surgery and the 5-year survival rate after salvage surgery was 29.1％.Conclusions T stag is the most important impacting factor for tumor recurrence.Salvage surgery with immediate reconstruction of major surgical defects should be carried out in the selective cases of recurrent sinonasal SCC.%目的 分析影响鼻-鼻窦鳞状细胞癌治疗后复发的相关临床病理学因素,探讨复发性鼻-鼻窦癌挽救手术治疗方法的有效性及可行性.方法 回顾性分析1996-2007年白求恩国际和平医院耳鼻咽喉头颈外科收治的107例原发鼻-鼻窦鳞状细胞癌患者临床及病理学资料,采用Logistic 回归模型分析与复发有关的临床病理学因素；根据肿瘤的复发状况和侵及范围以及术前全面评估结果,选择性地对治疗后复发病例实施不同方式手术切除,手术进路包括侧鼻切开、面部正中翻揭手术和颅面联合进路等,通过多种组织瓣技术包括阔肌筋膜瓣、帽状腱膜骨膜瓣、颞肌筋膜瓣、胸大肌肌皮瓣、游离前臂皮瓣和游离腹直肌肌皮瓣修复切除术后的重要缺损；对所有患者进行常规随访,通过直接法和Kaplan-Meier法计算107例患者和再手术患者的5年生存率.结果 107例患者的5年生存率为52.39％(56/107).术后随访发现,44例患者出现治疗后复发.Logistic回归分析证明,影响鼻-鼻窦鳞癌治疗后复发的主要临床病理学因素为肿瘤T分期(OR=0.258,P=0.001).对复发病例中的34例实施了挽救手术切除,术后复发患者挽救手术的5年生存率为29.1％.结论 原发肿瘤的T分期是影响鼻-鼻窦鳞状细胞癌治疗后复发最重要的危险因素.对于治疗后复发的鼻-鼻窦癌,通过充分术前评估选择性实施挽救性手术能够延长部分患者的生存时间.