鼻腔鼻窦肠型腺癌的眶尖受累：对远处转移和死亡率的影响

文献信息

中文摘要

引言： 鼻腔鼻窦肠型腺癌（ITAC）常在晚期才被诊断。肿瘤向与眶和颅底相邻的关键解剖区域延伸会强烈影响预后，因为这些区域难以实现阴性切缘。
目的： 确定ITAC患者远处转移和疾病特异性死亡的预测因素，重点关注关键解剖结构的受累情况。
方法： 对2010年至2024年间在一家三级中心诊断的ITAC病例进行回顾性分析。收集临床表现、影像学、组织病理学、治疗方式和结局数据。进行单因素和多因素分析，以确定远处转移和疾病特异性死亡的预测因素。
结果： 共纳入34例ITAC病例。21.2%的病例发生远处转移；眶尖受累（p = 0.007）和翼腭窝受累（p = 0.034）在单因素分析中具有显著性，多因素分析中仅眶尖受累仍具有显著性（p = 0.024）。关于ITAC特异性死亡率，眶尖受累（p = 0.002）、复发（p = 0.043）和辅助放疗（p = 0.045）为相关因素，其中放疗显示出保护作用。多因素分析证实眶尖是死亡率的预测因素（p = 0.002），而辅助放疗具有临界关联（p = 0.050）。
结论： 眶尖受累独立提示ITAC远处转移和疾病特异性死亡的高风险；此类患者值得接受个体化、强化的多模式管理。辅助放疗可能带来保护性获益，尤其是在晚期疾病中。

英文摘要

INTRODUCTION: Sinonasal intestinal-type adenocarcinoma (ITAC) is often diagnosed at advanced stages. Prognosis is strongly influenced by tumor extension into critical anatomical regions contiguous with the orbit and skull base, where achieving negative margins is challenging.
OBJECTIVE: To identify predictors of distant metastasis and disease-specific mortality in patients with ITAC, focusing on involvement of critical anatomical structures.
METHODS: Retrospective analysis of ITAC cases diagnosed between 2010 and 2024 at a tertiary center. Data on clinical presentation, imaging, histopathology, treatment modalities, and outcomes were collected. Uni- and multivariate analyses were performed to identify predictors of distant metastasis and disease-specific mortality.
RESULTS: Thirty-four ITAC cases were included. Distant metastasis occurred in 21.2% of cases; orbital apex ( p  = 0.007) and pterygopalatine fossa ( p  = 0.034) involvement were significant in univariate analysis, with only orbital apex remaining significant in multivariate analysis ( p  = 0.024). Regarding ITAC-specific mortality, orbital apex involvement ( p  = 0.002), relapse ( p  = 0.043), and adjuvant radiotherapy ( p  = 0.045) were associated factors, with radiotherapy showing a protective effect. Multivariate analysis confirmed orbital apex as a predictor of mortality ( p  = 0.002), while adjuvant radiotherapy had a borderline association ( p  = 0.050).
CONCLUSION: Orbital apex involvement independently signals high risk of distant metastasis and disease-specific death in ITAC; such patients merit individualized, intensified multimodal management. Adjuvant radiotherapy may confer a protective benefit, particularly in advanced-stage disease.