头颈部血管外皮瘤治疗及预后

阿里木江·吾守; 苗辛超; 赵雅君

doi:10.13201/j.issn.1001-1781.2014.23.011

头颈部血管外皮瘤治疗及预后

- 1 复旦大学附属肿瘤医院肿瘤研究所复旦大学上海医学院肿瘤学系(上海, 200032);
- 2 上海交通大学附属第九人民医院口腔颌面外科;
- 3 西安交通大学附属口腔医院口腔颌面外科

详细信息

通讯作者: 阿里木江·吾守,E-mail:alimjan.wushur@gmail.com

中图分类号: R739.91

收稿日期: 2014-02-07

Treatment outcome and prognosis of head and neck hemangiopericytoma

- 1 Cancer Research Institute, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China;
- 2 Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University;
- 3 Department Oral & Maxillofacial Surgery, College and Hospital of Stomatology, Xi'an Jiao Tong University

More Information

Corresponding author: WUSHOU Alimujiang, E-mail: alimjan.wushur@gmail.com

Received Date: 07 February 2014

摘要

摘要: 目的:探讨头颈部血管外皮瘤(HNHPC)的特异性临床病理特征、治疗及预后因素。方法:从PubMed、Embase、Google scholar、中国知网、万方及维普电子数据库中,收集2013年12月31日之前发表且包含治疗、随访和预后的中、英文HNHPC病例报告,进行回顾性分析。结果:纳入文献共122篇,总计有213例HNHPC病例纳入统计学分析。HNHPC复发率为24.4%(51/209),阳性手术切缘(OR=3.977,P<0.01)及低分化病理类型(OR=1.890,P<0.01)使HNHPC局部复发风险增加。HNHPC转移率为15.8%(22/139),阳性手术切缘(OR=13.833,P<0.01)、低分化病理类型(OR=4.661,P<0.01)及非手术治疗(OR=2.000,P<0.01)与HNHPC转移率上升有关。HNHPC死亡率为15.0%(32/213),肿瘤直径＞5.0 cm(OR=2.860,P<0.05)、阳性手术切缘(OR=9.833,P<0.01)、低分化病理类型(OR=4.061,P<0.01)、非手术治疗(OR=2.032,P<0.01)均为增加死亡风险的因素。单纯手术者139例,综合治疗64例,非手术治疗者10例。HNHPC总生存率(OS)为85%;3、5、10年OS分别为86%、78%和74%,其中单纯手术者OS分别为95%、88%和84%,手术加放疗者分别为90%、80%和80%,手术加化疗者分别为75%、25%和25%,手术加放化疗者分别为67%、58%和46%。HNHPC手术切缘与无复发生存率(RFS),无转移生存率(MFS)和OS之间均有生存差异(P<0.01)。HNHPC病理分化与RFS、MFS和OS之间有生存差异(P<0.01)。HNHPC治疗方式与MFS和OS之间均有生存差异(P<0.01)。HNHPC的OS在不同肿瘤大小之间存在差异(P<0.05)。阳性手术切缘为术后复发的独立预测因素(HR=3.680, P<0.01),低分化病理类型为术后转移和死亡的独立预测因素(HR=2.619, P<0.05和HR=3.188,P<0.05),肿瘤直径>5.0 cm和非手术治疗是死亡的独立预测因素(HR=5.461, P<0.01和HR=8.563, P<0.01)。结论:手术治疗是HNHPC主要治疗方式且优于综合治疗。手术切缘、肿瘤大小、病理分化和非手术治疗是HNHPC预后的独立预测因素。
- 血管外皮瘤 /
- 头颈部 /
- 治疗 /
- 预后
Abstract: Objective:Aim of the study is to report the unique clinicopathologic feature, treatment outcome and prognostic factors of head and neck hemangiopericytoma (HNHPC).Method:A retrospective data collection of reported HNHPC cases, in which therapy, follow-up and outcome data were available, was performed from the electronic database of PubMed, Embase, Google scholar, China National Knowledge Infrastructure, Wan Fang and Wei Pu until on December 31, 2013.Result:A total of 213 HNHPC cases were identified from 122 peer-reviewed articles. The recurrence rate was 24.4% (51/209). The positive surgical margin (OR=3.977, P<0.01) and poor pathologic differentiation (OR=1.890, P<0.01) were associated with increased local recurrence. The metastasis rate was 15.8% (22/139). The positive surgical margin (OR=13.833, P<0.01), poor pathologic differentiation (OR=4.661, P<0.01) and non-surgical treatment (OR=2.000, P<0.01) were associated with increased distant metastasis. The mortality rate was 15.0% (32/213). The tumor size >5.0 cm in diameter (OR=2.860, P<0.05), positive surgical margin (OR=9.833, P<0.01), poor pathologic differentiation (OR=4.061, P<0.01) and non-surgical treatment (OR=2.032, P<0.01) were associated with worse mortality. The treatment included surgery alone 139 cases, multiple treatments 64 cases and non-surgical treatment 10 cases. The overall survival (OS) of the 213 cases was 85%, and the 3-year, 5-year and 10-year OS were 86%, 78% and 74%, respectively. The 3-year, 5-year and 10-year OS for surgery alone were 95%, 88% and 84%, respectively. The 3-year, 5-year and 10-year OS for surgery plus radiotherapy were 90%, 80% and 80%, respectively. The 3-year, 5-year and 10-year OS for surgery plus chemotherapy were 75%, 25% and 25%, respectively. The 3-year, 5-year and 10-year OS for surgery plus radio-chemotherapy were 67%, 58% and 46%, respectively. There were significant survival difference in recurrence-free survival (RFS), metastasis free survival (MFS) and OS depending on surgical margins (P<0.01). RFS, MFS and OS difference were identified depending on pathologic differentiation (P<0.01). MFS and OS differences were observed on the different treatment modality (P<0.01). OS differences was observed on the different tumor sizes (P<0.05). Positive surgical margins was correlated with disease recurrence (HR=3.680, P<0.01), while poor pathologic differentiation was correlated with metastasis and death (HR=2.619, P<0.05 and HR=3.188, P<0.05). The tumor size >5.0 cm in diameter and non-surgical treatment was correlated with death (HR=5.461, P<0.01 and HR=8.563, P<0.01, respectively).Conclusion:The surgical resection was the mainstream treatment and it was superior to multiple treatments. The tumor size, surgical margins, pathological differentiation and non-surgical treatment were independent prognostic factors.
- hemangiopericytoma /
- head and neck /
- management /
- outcome

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