鼻窦腺癌的影像学肿瘤钙化：患病率及预后意义
Radiological Tumor Calcification in Sinonasal Adenocarcinoma: Prevalence and Prognostic Implications.
文献信息
| PMID | 42781376 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Julia Fanchette |
| 作者单位 | Department of Otorhinolaryngology, Lariboisière Hospital, APHP Université Paris Cité Paris France. |
| 期刊 | Laryngoscope investigative otolaryngology |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 鼻窦腺癌的影像学瘤内钙化研究甚少。本研究旨在评估其患病率，评价其潜在预后意义，并探讨其与手术可切除性的关联。
材料与方法： 我们开展了一项回顾性单中心研究，纳入接受根治性治疗的鼻窦腺癌患者。回顾了临床、病理、治疗及计算机断层扫描（CT）数据。术前CT评估瘤内弥漫性钙化。采用适当的统计方法（包括Cox比例风险模型）分析其与肿瘤特征、手术结局及生存的关联。
结果： 共纳入96例患者。24例（25%）发现瘤内钙化。与无钙化患者相比，有钙化者更常为局部晚期肿瘤（pT3-4：79.2% vs. 47.2%，p=0.013；pT4：62.5% vs. 31.9%，p=0.025），更可能接受诱导化疗（33.3% vs. 9.7%，p=0.015），且不完全切除率更高（R2：20.0% vs. 1.5%，p=0.007）。组织学亚型和分化分级在两组间相似。调整pT分期后，与R2切除的关联仍存在（惩罚逻辑回归：OR 7.74，95% CI 1.26-82.61；p=0.026）。在单变量分析中，钙化与较差的无病生存相关（HR 2.36，95% CI 1.23-4.54；p=0.010），但调整pT分期后（HR 1.47，95% CI 0.76-2.88；p=0.26）或多变量分析中（HR 1.41，95% CI 0.70-2.85；p=0.34）该关联未持续存在。钙化与总生存无关。
结论： 瘤内影像学钙化存在于25%的鼻窦腺癌中，与更晚期的局部病变及更高的不完全切除风险相关。尽管在未调整分析中与较差的无病生存相关，但调整肿瘤分期后该效应减弱。这些发现提示钙化主要反映局部肿瘤范围；虽非独立生存因素，但其与不完全切除的独立关联可能使其成为手术难度的有用术前标志物。
证据等级： 3。
英文摘要
OBJECTIVES: Radiological intratumoral calcifications in sinonasal adenocarcinoma have been scarcely investigated. This study aimed to assess their prevalence and evaluate their potential prognostic significance and to examine its association with surgical resectability.
MATERIALS AND METHODS: We conducted a retrospective single-center study including patients treated with curative intent for sinonasal adenocarcinoma. Clinical, pathological, treatment, and computed tomography (CT) data were reviewed. Intratumoral diffuse calcifications were assessed on preoperative CT. Associations with tumor characteristics, surgical outcomes, and survival were analyzed using appropriate statistical methods, including Cox proportional hazards models.
RESULTS: Ninety-six patients were included. Intratumoral calcifications were identified in 24 patients (25%). Compared with patients without calcifications, those with calcifications more frequently had locally advanced tumors (pT3-4: 79.2% vs. 47.2%, p = 0.013; pT4: 62.5% vs. 31.9%, p = 0.025), were more likely to receive induction chemotherapy (33.3% vs. 9.7%, p = 0.015), and had a higher rate of incomplete resection (R2: 20.0% vs. 1.5%, p = 0.007). Histological subtype and differentiation grade were similar between groups. The association with R2 resection persisted after adjustment for pT stage (penalized logistic regression: OR 7.74, 95% CI 1.26-82.61; p = 0.026). In univariable analysis, calcifications were associated with worse disease-free survival (HR 2.36, 95% CI 1.23-4.54; p = 0.010), but this association did not persist after adjustment for pT stage (HR 1.47, 95% CI 0.76-2.88; p = 0.26) or in multivariable analysis (HR 1.41, 95% CI 0.70-2.85; p = 0.34). Calcifications were not associated with overall survival.
CONCLUSION: Intratumoral radiological calcifications were present in 25% of sinonasal adenocarcinomas and were associated with more advanced local disease and a higher risk of incomplete resection. Although associated with poorer disease-free survival in unadjusted analyses, this effect was attenuated after adjustment for tumor stage. These findings suggest that calcifications primarily reflect local tumor extent; although not an independent survival factor, their independent association with incomplete resection may make them a useful preoperative marker of surgical difficulty.
LEVEL OF EVIDENCE: 3.