Oncologic outcomes of surgical treatments of advanced sinonasal malignancies.
10.3760/cma.j.cn115330-20221001-00588
- VernacularTitle:晚期鼻腔鼻窦恶性肿瘤的手术疗效观察
- Author:
Meng Yu CHEN
1
;
Yi Hui WEN
1
;
Xin WEN
1
;
Rui HE
1
;
Zi Xuan HUANG
1
;
Jian LI
1
;
Wei Ping WEN
1
Author Information
1. Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Sun Yat-sen University, the Institute of Otorhinolaryngology of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Guangzhou 510080, China.
- Publication Type:Journal Article
- MeSH:
Male;
Female;
Humans;
Adult;
Middle Aged;
Aged;
Retrospective Studies;
Prognosis;
Combined Modality Therapy;
Melanoma/surgery*;
Endoscopy
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2023;58(5):431-437
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the prognoses of advanced (T3-T4) sinonasal malignancies (SNM). Methods: The clinical data of 229 patients with advanced (T3-4) SNM who underwent surgical treatments in the First Affiliated Hospital of Sun Yat-sen University from 2000 to 2018 were retrospectively analyzed, including 162 males and 67 females, aged (46.8±18.5) years old. Among them, 167 cases received endoscopic surgery alone, 30 cases received assisted incision endoscopic surgery, and 32 cases received open surgery. The Kaplan-Meier method was used to estimate the 3-year and 5-year overall survival (OS) and event-free survival (EFS). Univariate and multivariate Cox regression analyses were performed to explore significant prognostic factors. Results: The 3-year and 5-year OS were respectively 69.7% and 64.0%. The median OS time was 43 months. The 3-year and 5-year EFS were respectively 57.8% and 47.4%. The median EFS time was 34 months. The 5-year OS of the patients with epithelial-derived tumors was better than that of the patients with mesenchymal-derived tumors and malignant melanoma (5-year OS was respectively 72.3%, 47.8% and 30.0%, χ2=36.01, P<0.001). Patients with microscopically margin-negative resection (R0 resection) had the best prognosis, followed by macroscopically margin-negative resection (R1 resection), and debulking surgery was the worst (5-year OS was respectively 78.4%, 55.1% and 37.4%, χ2=24.63, P<0.001). There was no significant difference in 5-year OS between the endoscopic surgery group and the open surgery group (65.8% vs. 53.4%, χ2=2.66, P=0.102). Older patients had worse OS (HR=1.02, P=0.011) and EFS (HR=1.01, P=0.027). Patients receiving adjuvant therapy had a lower risk of death (HR=0.62, P=0.038). Patients with a history of nasal radiotherapy had a higher risk of recurrence (HR=2.48, P=0.002) and a higher risk of death (HR=2.03, P=0.020). Conclusion: For patients with advanced SNM, the efficacy of endoscopic surgery can be comparable to that of open surgery when presence of safe surgical margins, and a treatment plan based on transnasal endoscopic surgery as the main comprehensive treatment is recommended.
