| Objective: In this study,retrospective analysis on the clinical features of nasal cavity and paranasal sinus carcinoma was performed to explore factors that influenced prognosis and surgical treatment.Methods: This study is a retrospective review of a single center.Hospital records of 120 patients with biopsy proven carcinoma of nasal cavity and paranasal sinus were studied.Only the patients undergoing surgery in the First Hospital of China Medical University from November 2010 to August 2017 were included.Prognostic analysis was performed to study the following variables: age,sex,histopathological type,initial location,N classification,extension to orbit,skull base,intracranial invasions,surgical margin status,and therapeutic aspects.Their impacts on overall survival was established using the Kaplan-Meier method.A search for prognostic factors was made using a log-rank test.The variables that were found to be significantly different by univariate analyses were subjected to multivariate logistic regression analysis and Cox's proportional hazard model.Results: The most frequent initial symptom of the patients was nasal obstruction.The most common tumor location was nasal cavity in 43 cases(35.8%),followed by maxillary sinus in 38 cases(31.7%),ethmoid in 23 cases(19.2%),sphenoid in 11 cases(9.2%),and frontal in 4 cases(3.3%).About half of the patients presented with stage ? or locally advanced disease(50.8%).All patients underwent surgery,with 87 cases by an endoscopic approach and 33 cases by an open approach.The overall survival rates of the two approaches were 77.0% and 78.8%,respectively,without any significance(p = 0.093).After the surgery,104 patients(86.7%)underwent radiotherapy,among which 19 patients underwent additional chemotherapy.The median follow-up was 35.1(range 4-81)months.By the time of the study,24 patients had died of the tumors.Local recurrence was the most common cause of death,followed by distant metastasis.The most common site of distant metastasis was lung,while metastasis to cervical lymph nodes was rare.Overall survival rates at 1,3,and 5 years were 75.0%,71.4%,and 66.7%,respectively.Disease-free survival rates at 1,3,and 5 years were 60.2%,51.8% and 40.7%,respectively.On univariate analysis,N status(p = 0.035),TNM classification(p = 0.015),ASA status(p = 0.041),tumor size(p = 0.008),surgical margin status(p < 0.001),and involvement of sphenoid sinus(p = 0.015)were significantly associated with overall survival.Multivariate Cox analysis revealed that only N status(p = 0.036),ASA status(p = 0.001),and surgical margin status(p < 0.001)were significantly and independently associated with prognosis.Multivariate logistic regression analysis indicated that disease presentation(p = 0.026)and surgical margin status(p < 0.001)were associated with recurrence or metastasis.Conclusion: The present study has demonstrated that N status,ASA status,and surgical margin status were the most significant factors affecting prognosis.The disease presentation and surgical margin status seemed to be the important factors to affect recurrence or metastasis.In carefully selected patients,endoscopic approaches demonstrated survival rates comparable to those of traditional surgery.With appropriate planning and careful surgical decision-making,endoscopic surgery shows promise as a minimally invasive alternative in the treatment of nasal cavity and paranasal sinus carcinoma.Local recurrence was the major cause of treatment failure.Long-term surveillance and regular examination of all patients for recurrence and metastasis is essential to early clinical intervention. |
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