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目的:回顾性分析鼻腔鼻窦腺样囊性癌(ACC)的临床特征及预后差异。方法:搜集2007-2017年收治的鼻腔鼻窦ACC患者67例,重点分析其病例特征、手术方式,并采用寿命表法、Kaplan-Meir法及Cox比例风险模型分别进行生存及复发结局的生存分析。结果:中位生存时间为6.68年,1年、5年、10年生存率分别为95%、79%、67%。单因素分析显示性别、年龄、首发症状至确诊时间、肿瘤位置、临床分期及Ki-67阳性率与鼻腔鼻窦ACC的预后相关,多因素分析显示性别、首发症状至确诊时间、Ki-67阳性率可作为评价鼻腔鼻窦ACC患者预后的独立危险因素。中位复发时间为6.13年,1年、3年、5年复发率分别为5%、7%、9%。性别、首发症状至确诊时间、切缘情况及Ki-67阳性率与鼻腔鼻窦ACC的复发相关,首发症状至确诊时间、切缘情况、Ki-67阳性率可作为评价鼻腔鼻窦ACC患者复发风险的独立危险因素。结论:性别、首发症状至确诊时间、Ki-67阳性率可作为评价鼻腔鼻窦ACC患者预后的指标。首发症状至确诊时间、切缘情况、Ki-67阳性率可作为评价鼻腔鼻窦ACC患者复发风险的指标。首发症状至确诊时间及Ki-67阳性率能同时指示复发且能同时提示复发及死亡风险,因此针对首发症状至确诊时间长及Ki-67阳性率>30%的患者应缩短复查周期。而手术切缘情况对肿瘤复发风险有指示作用,而对患者远期死亡风险并无明显影响,临床医生应重视各项指示预后的指标,针对较差预后患者,缩短复查时间,改善患者预后。
Objective: To retrospectively analyze the clinical characteristics and prognosis of nasal sinus adenoid cystic carcinoma (ACC). Methods: A total of 67 ACC patients with nasal and sinuses were collected from 2007 to 2017. The characteristics of the cases and surgical methods were analyzed. Survival analysis of survival and recurrence outcomes were performed by life table method, Kaplan-Meir method and Cox proportional hazards model respectively. Results: The median survival time was 6. 68 years, 1 year, 5 years, 10 years survival rates were 95%, 79%, 67%. Univariate analysis showed that sex, age, first symptom to time of diagnosis, tumor location, clinical stage and positive rate of Ki-67 were correlated with the prognosis of nasal sinus. The multivariate analysis showed that gender, initial symptom to definite diagnosis time and Ki-67 positive rate It can be used as an independent risk factor to evaluate the prognosis of nasal sinuses with ACC. The median time to relapse was 6.13 years, 1 year, 3 years, and 5 years, with recurrence rates of 5%, 7%, and 9%, respectively. Sex, the first symptom to the time of diagnosis, the margins and the positive rate of Ki-67 were related to the recurrence of ACC in nasal sinuses, and the first symptom to the time of diagnosis, the margin of incision and Ki-67 positive rate could be used to evaluate the recurrence risk of nasal sinus Independent risk factors. Conclusion: The gender, the first symptom to the time of diagnosis, the positive rate of Ki-67 can be used as the index to evaluate the prognosis of nasal sinuses with ACC. The first symptom to the time of diagnosis, margins, Ki-67 positive rate can be used as indicators to evaluate the risk of nasal sinus recurrence in patients with ACC. Initial symptoms to the time of diagnosis and Ki-67 positive rate can also indicate the recurrence and can simultaneously show the risk of recurrence and death, so for the first symptom to confirm the long time and Ki-67 positive rate> 30% of patients should shorten the review cycle. However, the surgical margins indicate the risk of tumor recurrence, but have no significant effect on the long-term mortality risk of patients. Clinicians should pay attention to the indicators of prognosis, shorten the time of review, and improve the prognosis of patients with poor prognosis.