在过去的20年里,经鼻内镜手术(TES)已成为治疗鼻窦恶性肿瘤最常用的手术技术。鼻窦肿瘤的稀有性和异质性阻碍了大规模的非人群分析。
纳入了1995年至2021年在5家转诊医院接受TES治疗的所有患者。进行了预后研究,将多变量模型转化为列线图。培训和验证集基于3个欧洲中心和2个非欧洲中心的结果,分别。
训练和验证集包括940名和420名患者,分别。手术的平均年龄,原发性与复发性表现,组织学分布,手术类型,T类别和辅助治疗的类型在训练和验证集中分布不同。在训练集中,5年总生存率和无复发生存率,置信区间为95%,分别为72.7%(69.5-76.0%)和66.4%(63.1-69.8%),分别,随组织学显著变化。在多变量分析中,年龄,性别,以前的治疗,颅骨切除的程度,外侧和后外侧轴,等级/子类型,T类,节点状态,切缘状态和辅助治疗均与不同的预后结局相关,根据组织学显示异质意义和效应大小。除粘膜黑素瘤外,所有组织学的列线图的内部和外部验证均令人满意(乐观校正的C指数>0.7,曲线下累积面积>0.7)。
基于TES的鼻窦癌治疗的结果随组织学而显著不同。这么大,非基于人群的研究提供了被认为适合包括TES在内的治疗的鼻窦癌预后的基准数据.
Over the last 2 decades, transnasal endoscopic surgery (TES) has become the most frequently employed surgical technique to treat
sinonasal malignancies. The rarity and heterogeneity of
sinonasal cancers have hampered large non-population-based analyses.
All patients receiving TES-including treatment between 1995 and 2021 in 5 referral hospitals were included. A prognostic
study was performed, and multivariable models were transformed into nomograms. Training and validation sets were based on results from 3 European and 2 non-European centres, respectively.
The training and validation set included 940 and 420 patients, respectively. The mean age at surgery, primary-versus-recurrent presentation, histology distribution, type of surgery, T category and type of adjuvant treatment were differently distributed in the training and validation set. In the training set, 5-year overall survival and recurrence-free survival with a 95%-confidence interval were 72.7% (69.5-76.0%) and 66.4% (63.1-69.8%), respectively, significantly varying with histology. At multivariable analyses, age, gender, previous treatment, the extent of resection on the cranial, lateral and posterolateral axes, grade/subtype, T category, nodal status, margin status and adjuvant treatment were all associated with different prognostic outcomes, displaying a heterogeneous significance and effect size according to histology. The internal and external validation of nomograms was satisfactory (optimism-corrected C-index >0.7 and cumulative area under curve >0.7) for all histologies but mucosal melanoma.
Outcomes of TES-based treatment of
sinonasal cancers vary substantially with histology. This large, non-population-based
study provides benchmark data on the prognosis of
sinonasal cancers that are deemed suitable for treatment including TES.