导航引导下鼻腔鼻窦及鼻咽恶性肿瘤亚临床局部侵犯的空间定位
Navigation-Guided Spatial Mapping of Subclinical Local Invasion in Sinonasal and Nasopharyngeal Malignancies.
文献信息
| PMID | 42922403 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Piergiorgio Gaudioso |
| 作者单位 | Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience (DNS), University of Padova, Padova, Italy. |
| 期刊 | International forum of allergy & rhinology |
| SCI 分区 | Q1 |
| IF | 4.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 影像学可见边界之外的亚临床局部侵犯（SLI）是鼻腔鼻窦及鼻咽恶性肿瘤（SNNM）治疗中的主要挑战。该现象背后的生物学行为仍缺乏充分表征，尤其是其空间范围和依赖组织学的模式。
方法： 本前瞻性研究纳入接受SNNM手术切除并术中使用手术导航（SN）的患者。对术中活检进行系统定位，并与术前影像进行空间关联。多变量logistic回归模型评估阳性活检概率、距大体肿瘤表面的距离与组织学特征之间的关联。
结果： 共分析54例患者和569份活检；78份（13.7%）为阳性。观察到距大体肿瘤表面距离与阳性活检概率之间呈显著负相关，每毫米优势约降低5.1%（p值<0.001）。距离校正后，组织学类型仍与阳性活检概率独立相关（p值<0.001）。腺样囊性癌（ACC）、伴神经周围侵犯（PNI）的鳞状细胞癌（SCC）、其他低分化癌（OPDC）及间叶性恶性肿瘤显示更广泛的SLI，而不伴PNI的SCC、肠型腺癌（ITAC）和嗅神经母细胞瘤（ONB）的SLI有限。组织特异性效应总体有限，尽管在ACC中神经组织与阳性活检概率增加相关。
结论： SNNM中的SLI遵循距离依赖模式，且距离-侵犯关系因组织学亚型而异。基于SN的定位是一种空间信息化的策略，可增强切缘评估并指导组织学驱动的手术和放疗计划。
要点： 导航引导定位有助于估计显微镜下肿瘤扩散模式。亚临床浸润概率自肿瘤边缘起每毫米约降低5.1%。组织学亚型影响显微镜下局部侵犯的范围。ACC显示最广泛的显微镜下局部侵犯，其次为伴PNI的SCC。PNI增加鼻腔鼻窦鳞状细胞癌的肿瘤扩散。
英文摘要
BACKGROUND: Subclinical local invasion (SLI) beyond radiologically evident margins poses a major challenge in the management of sinonasal and nasopharyngeal malignancies (SNNM). The biological behavior underlying this phenomenon remains poorly characterized, particularly regarding its spatial extent and histology-dependent patterns.
METHODS: This prospective study included patients undergoing surgical resection of SNNM with intraoperative surgical navigation (SN). Intraoperative biopsies were systematically mapped and spatially correlated with preoperative imaging. Multivariable logistic regression models evaluated the association between positive biopsy probability, distance from the gross tumor surface, and histologic characteristics.
RESULTS: Fifty-four patients and 569 biopsies were analyzed; 78 (13.7%) were positive. A significant inverse association between distance from the gross tumor surface and positive biopsy probability was observed, with an approximately 5.1% reduction in odds per millimeter (p-value < 0.001). Histologic type remained independently associated with positive biopsy probability after distance adjustment (p-value < 0.001). Adenoid cystic carcinoma (ACC), squamous cell carcinoma (SCC) with perineural invasion (PNI), other poorly differentiated carcinomas (OPDC), and mesenchymal malignancies showed wider SLI, whereas SCC without PNI, intestinal-type adenocarcinoma (ITAC), and olfactory neuroblastoma (ONB) demonstrated limited SLI. Tissue-specific effects were generally limited, although neural tissue was associated with increased positive biopsy probability in ACC.
CONCLUSIONS: SLI in SNNM follows a distance-dependent pattern with the distance-invasion relationship varying according to histologic subtype. SN-based mapping represents a spatially informed strategy to enhance margin assessment and guide histology-driven surgical and radiotherapy planning.
KEY POINTS: Navigation-guided mapping helped to estimate microscopic tumor spread patterns. Subclinical infiltration probability decreases by approximately 5.1% per mm from the tumor margin. Histologic subtype influences the extent of microscopic local invasion. ACC showed the widest microscopic local invasion, followed by SCC with PNI. PNI increased the tumor spread in sinonasal squamous carcinoma.