鼻内翻性乳头状瘤恶变32例临床分析

摘要

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.%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.