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背景与目的:随着电镜和免疫组化诊断技术的提高,关于嗅神经母细胞瘤和嗅神经上皮瘤的报道逐渐增多。本研究回顾性分析嗅神经母细胞瘤和嗅神经上皮瘤的临床特点和治疗效果,探讨其治疗方法。方法:嗅神经母细胞瘤和嗅神经上皮瘤在临床上被认为是同一种疾病,故将经病理证实的19例嗅神经母细胞瘤和10例嗅神经上皮瘤共同分析。其中单纯放疗10例,术前放疗15例,术后放疗4例。根据Kad ish分期标准,A期3例,B期8例,C期18例。生存分析采用Kap lan-m e ier法及Log rank检验。结果:患者表现为单侧鼻塞、单侧鼻衄或两者兼有者有26例,为89.66%。初次就诊时有颈淋巴结转移者5例,为17.24%。全组5年生存率、5年无瘤生存率分别为70.76%、66.48%。病理诊断为嗅神经母细胞瘤和嗅神经上皮瘤患者5年生存率及5年无瘤生存率比较差异无显著性。A/B期、C期5年生存率分别为100.00%、54.32%。有颈淋巴结转移者(N+)和无颈淋巴结转移者(N0)4年无瘤生存率分别为60.00%、71.05%(P<0.05)。结论:淋巴结转移是一个预后不良的因素,随着内镜手术的使用,放疗成为嗅神经母细胞瘤(嗅神经上皮瘤)的主要治疗方法。
BACKGROUND & OBJECTIVE: With the improvement of electron microscopy and immunohistochemical techniques, the reports of olfactory neuroblastoma and olfactory neuroepithelioma are gradually increasing. This study retrospectively analyzed the clinical features and therapeutic effects of olfactory neuroblastoma and olfactory neuroepithelioma and explored its treatment. Methods: Olfactory neuroblastoma and olfactory neuroepithelioma are considered to be the same disease clinically. Therefore, 19 cases of olfactory neuroblastoma confirmed by pathology and 10 cases of olfactory neuroepithelioma were analyzed together. Among them, 10 cases received radiotherapy alone, 15 cases received preoperative radiotherapy and 4 cases received postoperative radiotherapy. According to Kad ish staging criteria, 3 cases in stage A, 8 cases in stage B and 18 cases in stage C. Survival analysis using Kaplan-Meier method and Log rank test. Results: The patients showed unilateral nasal obstruction, unilateral nasal discharge or both, 26 cases (89.66%). In the first visit, there were 5 cases of cervical lymph node metastasis, which was 17.24%. The 5-year overall survival rate, 5-year disease-free survival rates were 70.76%, 66.48%. Pathological diagnosis of olfactory neuroblastoma and olfactory epithelial tumors in patients with 5-year survival rate and 5-year disease-free survival was no significant difference. The 5-year survival rates of A / B and C were 100.00% and 54.32% respectively. The 4-year disease-free survival rates of patients with cervical lymph node metastasis (N +) and those without cervical lymph node metastasis (N0) were 60.00% and 71.05%, respectively (P <0.05). Conclusion: Lymph node metastasis is a poor prognostic factor. With the use of endoscopic surgery, radiotherapy becomes the main treatment for olfactory neuroblastoma (olfactory neuroepithelioma).