上顎洞扁平上皮癌の臨床統計学的検討  [in Japanese] Statistical Analysis of Maxillary Sinus Squamous Cell Carcinoma  [in Japanese]

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Author(s)

    • 山下 拓 YAMASHITA Taku
    • 慶應義塾大学医学部耳鼻咽喉科学教室 Department of Otorhinolayngology, Keio University School of Medicine
    • 藤井 正人 FUJII Masato
    • 慶應義塾大学医学部耳鼻咽喉科学教室 Department of Otorhinolayngology, Keio University School of Medicine
    • 大野 芳裕 OHNO Yoshihiro
    • 慶應義塾大学医学部耳鼻咽喉科学教室 Department of Otorhinolayngology, Keio University School of Medicine
    • 徳丸 裕 TOKUMARU Yutaka
    • 慶應義塾大学医学部耳鼻咽喉科学教室 Department of Otorhinolayngology, Keio University School of Medicine
    • 菅家 稔 KANKE Minoru
    • 慶應義塾大学医学部耳鼻咽喉科学教室 Department of Otorhinolayngology, Keio University School of Medicine
    • 冨田 俊樹 TOMITA Toshiki
    • 慶應義塾大学医学部耳鼻咽喉科学教室 Department of Otorhinolayngology, Keio University School of Medicine
    • 神崎 仁 KANZAKI Jin
    • 慶應義塾大学医学部耳鼻咽喉科学教室 Department of Otorhinolayngology, Keio University School of Medicine
    • 犬山 征夫 INUYAMA Yukio
    • 北海道大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, Hokkaido University School of Medicine

Abstract

今後の上顎洞癌に対する治療方針決定の参考とすべく,当施設での臓器機能温存を目指した集学的治療の成績を示し,生存率および上顎温存率に影響する因子を統計学的に検討した.<br>対象は1981年1月から1998年12月までに当科を受診した上顎洞原発扁平上皮癌新鮮例60例.性別は男性46例,女性14例,年齢分布は36歳から86歳で平均59.8歳であった.1997年AJCCによるT分類はT1:0例,T2:7例,T3:41例,T4:12例で頸部リンパ節転移が7例(11.7%)に認められた.M1症例はみられなかった.このうち他因死例1例を除く59例を統計学的検討の対象とした.単変量解析として背景因子,治療因子別に累積生存率を算出し,Coxの比例ハザードモデルによる多変量解析により,予後因子の独立性およびハザード比を検討した.また累積上顎温存生存率も算出し,多変量解析により上顎温存に影響を与える因子につき検討した.その結果,死因特異的累積5年生存率は56.8%で,T2:68.6%,T3:60.0%,T4:41.7%であった.多変量解析ではT分類(p=0.0240)が独立した予後因子と判定された.上顎温存生存率に影響する因子は,多変量解析でT分類(p=0.0486)とNeoadjuvant chemotherapy (NAC)の有無(p=0.0419)であった.またNAC施行症例48例で検討した結果,NAC非奏効群は奏効群と比較して予後,上顎温存生存率ともに不良で,特にT4症例において統計学的有意差を認めた.<br>以上より,今後の治療成績向上のためには,T4症例でNAC非奏効の場合の治療法の再考が必要と考えられた.またNAC施行の上顎温存に対する有用性については,さらなるprospectiveな検討を要すると考えられた.

Cases of squamous cell carcinoma of the maxillary sinus initially treated at Keio University Hospital between January 1981 and December 1998 studied retrospectively involved 60 untreated cases-46 men and 14 women aged 36 to 86 years (mean: 59.8 years). Of these, 7 had T2, 41 T3 and 12 T4 tumors based on 1997 AJCC TNM classification. Seven (11.7%) had nodal involvement but none had distant metastasis at diagnosis. Of the 60, 53 (88.3%) were stage III or IV.<br>Prognostic factors and survival were statistically analyzed for 59 cases, excluding the 60th who died of another cause. Follow-up was 4 to 227 months, with a median of 59 months and a mean of 38 months. Of the 59, 48(81.4%) underwent neoadjuvant chemotherapy (NAC). Survival was estimated using the Kaplan-Meier method as univariate analysis. Cause-specific 5-year survival was 56.8% for all stages, 68.2% for T2, 60.0% for T3, and 41.7% for T4. T stage classification was thus a significant independent prognostic factor in multivariate analysis using Cox's proportional hazards model (p=0.0240). It also identified T stage classification (p=0.0486) and NAC (p=0.0419) as significant independent factors affecting survival with organ preservation.<br>We also statistically analyzed 48 cases treated with NAC, which showed complete response (CR) for 11, partial response (PR) for 25, no change (NC) for 11, and progressive disease (PD) for 1. Responders (CR+PR) showed significantly better survival and organ preservation than nonresponders (NC+PD). The NAC response enables us to predict prognosis. T4 cases without NAC response should be treated intensively.

Journal

  • Nippon Jibiinkoka Gakkai Kaiho

    Nippon Jibiinkoka Gakkai Kaiho 105(6), 732-740, 2002-06-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

References:  22

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008674929
  • NII NACSIS-CAT ID (NCID)
    AN00191551
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00306622
  • Data Source
    CJP  CJPref  J-STAGE 
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