Management und Prognose von Patienten mit Plattenepithelkarzinomen der Nasenhaupt- und Nasennebenhöhlen

 

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Zusammenfassung

Hintergrund:

Plattenepithelkarzinome der Nasenhaupthöhle und der Nasennebenhöhlen (NH/NNH) stellen eine sehr seltene Tumorentität dar. Wir möchten mit dieser Studie eine Übersicht über klinisch-pathologische Daten, Behandlungsstrategie sowie die Prognose geben.

Material und Methoden:

Es erfolgte eine retrospektive Analyse von 45 Patienten mit einem Plattenepithelkarzinom der NH/NNH (NH=35, NNH=10), die in den Jahren 1994 bis 2010 an der HNO-Klinik der Technischen Universität München therapiert wurden.

Ergebnisse:

Die Tumoren der NH wurden überwiegend im frühen Tumorstadium (97% T1 bzw. T2), die der NNH im fortgeschrittenen Tumorstadium (90% T3 bzw. T4) diagnostiziert. Nur bei zwei Patienten fanden sich bei Erstvorstellung pathologisch gesicherte Lymphknotenmetastasen. Bei 13 (29%) der Patienten war es zu einem lokalen Rezidiv (n=10) und/oder Tumorprogress mit Metastasen in regionären Lymphknoten (n=2) bzw. zu Fernmetastasen (n=4) gekommen. Das Plattenepithelkarzinom der NH/NNH zeigte eine schlechte Prognose (31% 5-Jahres-Überlebensrate, 5-JÜR). Speziell Patienten mit einem Rezidiv hatten ein schlechtes Gesamtüberleben (p=0,06). Statistisch signifikante Korrelationen zwischen klinisch-pathologischen Daten und den Überlebensdaten konnten nicht nachgewiesen werden.

Schlussfolgerung:

Plattenepithelkarzinome der NH/NNH haben eine schlechte Prognose. Die lokale Tumorkontrolle ist entscheidend für die Prognose. Eine abwartende Haltung hinsichtlich einer elektiven Neck dissektion erscheint vor allem dann gerechtfertigt, wenn klinisch kein Anhalt für eine Metastasierung in regionäre Lymphknoten besteht, da in unserem Kollektiv in nur 4% Lymphknotenmetastasen nachgewiesen werden konnten.

Abstract

Management and prognosis of patients with squamous cell carcinomas of the nasal cavity and the paranasal sinuses

Background:

Squamous cell carcinomas (SCC) of the nasal cavity and the paranasal sinuses are a very rare and poorly understood tumor entity. To date, no consistent management strategy exists. The purpose of our study was to demonstrate our therapeutic strategy and to correlate clinicopathological features with clinical follow-up data.

Material and methods:

45 patients with primarily resected SCC of the nasal cavity (n=35) and the paranasal sinuses (n=10) between 1994 and 2010 were reviewed retrospectively (mean follow-up period 2.6 years; range 0.3 to 14.9 years).

Results:

Tumors of the nasal cavity were diagnosed at an early stage (97% T1 and T2) whereas tumors of the parasinuses were found at an advanced stage (90% T3 and T4). Lymph node metastases were only found 2 patients. 13 patients (29%) had a local tumor progress, 2 patients showed lymph node metastases and 4 patients had distant metastases in follow up. The prognosis of tumors of the nasal cavitiy or the paranasal sinuses was bad (31% 5-year overall survival) especially by patients with a relapse.

Reconstructive surgery was performed after 12 months, when early local relapse could be excluded. There was no positive correlation between clinicopathological features and survival data.

Conclusion:

The prognosis of tumors of the nasal cavity and paranasal sinuses depends mainly on the control of local tumor growth. Modern strategies of surgical treatment in combination with radiotherapy need to be implemented in an effort to achieve continuous tumor-free survival.

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