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南昌大学第二附属医院肿瘤科
纸质出版日期:2017,
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曾小莉, 黄龙, 陈雅婕, 等. 187例中国嗅神经母细胞瘤的治疗疗效和预后因素分析[J]. 重庆医科大学学报, 2017,42(11):1469-1474.
Zeng Xiaoli, Huang Long, Chen Yajie, et al. Treatment outcome and prognostic factors of esthesioneuroblastoma:an analysis of 187 Chinese cases[J]. Journal of Chongqing Medical University, 2017,42(11):1469-1474.
曾小莉, 黄龙, 陈雅婕, 等. 187例中国嗅神经母细胞瘤的治疗疗效和预后因素分析[J]. 重庆医科大学学报, 2017,42(11):1469-1474. DOI: 10.13406/j.cnki.cyxb.001403.
Zeng Xiaoli, Huang Long, Chen Yajie, et al. Treatment outcome and prognostic factors of esthesioneuroblastoma:an analysis of 187 Chinese cases[J]. Journal of Chongqing Medical University, 2017,42(11):1469-1474. DOI: 10.13406/j.cnki.cyxb.001403.
目的:分析中国人群中嗅神经母细胞瘤(esthesioneuroblastoma
ENB)的治疗疗效及预后因素。方法:以"嗅神经母细胞瘤"为关键字在CNKI和万方数据库中进行检索
检索时限为1981-2015年。从病例报道和病例分析研究中共收集187例ENB病例
全部按Kadish分期标准进行分期
Kaplan-Meier法计算生存率。结果:研究共纳入187位ENB患者
中位随访时间为24个月(1
2
04个月)
患者的2年总生存率(overall survival
OS)为75.4%
2年无病生存率(disease-free survival
DFS)为52.9%。Kadish临床分期A期、B期、C期患者的2年OS分别为92%、96%、62.5%(χ2=21.724
P=0.000)
2年DFS分别为72%、66%、42.9%(χ2=14.874
P=0.000)。以手术联合放疗为主的综合治疗模式和其他治疗模式(包括单纯放疗、单纯手术、放疗+化疗、姑息治疗)的2年OS分别为84.5%和60.6%(χ2=15.283
P=0.000)
2年DFS分别为63.8%和35.2%(χ2=15.907
P=0.003)。有颈部淋巴结转移(N+)和无颈部淋巴结转移(N0)的2年OS分别为53.1%和80%(χ2=12.614
P=0.000)
2年DFS分别为34.4%和56.8%(χ2=8.722
P=0.003)。复发是治疗失败的主要模式
其中以远处转移预后最差。在187例患者中共有64例患者出现复发
复发率为34.2%
其中C期49例(43.8%)
增加化疗并不能减少C期患者的复发率
但颈部淋巴结清扫能减少N+患者的复发率。结论:手术联合放疗为主的综合治疗仍是目前ENB最佳的治疗模式
影响生存的主要因素为Kadish分期、治疗方式、复发和淋巴结情况
化疗的影响仍需进一步深入研究。
Objective:To analyze the treatment outcome and prognostic factors of esthesioneuroblastoma(ENB)in Chinese population.Methods:The CNKI and Wanfang database were searched with the key word of ‘esthesioneuroblastoma’
from 1981 to 2015. A total of 187 ENB cases were collected from case reports and case analysis studies. All patients were staged with Kadish criteria. KaplanMeier method was used to calculate the survival rates. Results:A total of 187 patients with ENB were brought into this study. The median follow-up time was 24 months(range from 1 month to 204 months). The 2-year overall survival(OS)and disease-free survival(DFS)rates were 75.4% and 52.9%
respectively. The 2-year OS and DFS of Kadish stage A
B
C were 92%
96%
62.5%(χ
2
=21.724
P=0.000)and 72%
66%
42.9%(χ
2
=14.874
P=0.000)
respectively. The 2-year OS was 84.5% for the patients treated with surgery combined radiotherapy with or without chemotherapy and 60.6% for those treated with other modalities(surgery alone
radiotherapy alone
chemotherapy and radiotherapy
palliative treatment)(χ
2
=15.283
P=0.000)
and the 2-year DFS were 63.8% and 35.2%(χ
2
=15.907
P=0.003)
respectively. The 2-year OS of patients with or without neck lymph nodal metastasis was 53.1% and 80%(χ
2
=12.614
P=0.000)
and the 2-year DFS were 34.4% and 56.8%(χ
2
=8.722
P=0.003)
respectively. The major pattern of treatment failure was recurrence
which distant metastasis was the worst. Eventually
64 of 187 patients(34.2%)relapsed after initial treatment including 49 patients(43.8%)at Kadish stage C. There was limited evidence to prove the role of chemotherapy for reducing relapse
while the use of elective neck dissection can reduce the recurrence of N+ patients. Conclusion:Combined treatment(surgery with radiotherapy) remains to be the optimum choice for ENB. The prognostic factors for survival are Kadish stage
treatment approaches
recurrence and lymph node metastasis
but the role of chemotherapy still requires further investigation.
嗅神经母细胞瘤综合治疗化疗
esthesioneuroblastomaCombined treatmentchemo therapy
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