外耳道腺样囊性癌的临床特征及预后分析

doi:10.3969/j.issn.1006-7795.2025.03.022

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (3): 559-566.doi: 10.3969/j.issn.1006-7795.2025.03.022

外耳道腺样囊性癌的临床特征及预后分析

武骏,赵茜,马廷耀,杨国梁,张姝晶,赵玥,刘懿萱,陈晓红^*

首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京 100730

收稿日期:2025-02-28 出版日期:2025-06-21 发布日期:2025-06-25
通讯作者: 陈晓红 E-mail:trchxh@163.com
基金资助:
国家自然科学基金项目（82173312 ，82372967）,首都卫生发展科研专项项目（2022-2-2057）,北京市医院管理中心“登峰”人才培养计划项目（DFL20220201）。

Clinical features and prognostic analysis of adenoid cystic carcinoma of the external auditory canal

Wu Jun, Zhao Xi, Ma Tingyao, Yang Guoliang, Zhang Shujing, Zhao Yue, Liu Yixuan, Chen Xiaohong^*

Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

Received:2025-02-28 Online:2025-06-21 Published:2025-06-25
Supported by:
These works were funded by the National Natural Science Foundation of China (82173312，82372967), Capital’s Funds for Health Improvement and Research (2022-2-2057), Beijing Hospital Management Center “Ascending the Peak” Talent Training Program ( DFL20220201).

摘要/Abstract

摘要： 目的探讨外耳道腺样囊性癌（adenoid cystic carcinoma, ACC）的临床特征、治疗策略及预后影响因素，为优化手术范围及辅助治疗提供依据。方法回顾性选取自2001年1月至2021年12月在北京同仁医院头颈外科就诊的58例病理确诊外耳道ACC患者为研究对象。所有患者均接受手术治疗，部分患者联合辅助放射治疗。主要观察结局为局部复发，次要结局包括总生存率和无局部复发生存率。采用Kaplan-Meier法进行生存分析，Cox回归模型分析影响复发的危险因素。结果全组患者中位随访时间为6.27（3.25, 11.30）年。1、3和5年总生存率分别为96.55%、91.37%和89.66%；T4期病例占比43.10%，提示外耳道ACC确诊时多已进展至局部晚期；23例（39.66%）患者出现局部复发，28例（48.28%）发生远处转移，其中肺转移占92.86%。多因素分析显示，实体型组织学模式（HR=2.729，95% CI：1.025 ~ 7.226，P =0.044）和神经周围浸润（perineural invasion, PNI）（HR=9.891，95% CI：3.525 ~ 27.752，P<0.01）是局部复发的独立危险因素。结论外耳道ACC具有较高的局部复发和远处转移风险，实体型组织学模式和神经周围浸润是其重要的预后影响因素。

关键词: 腺样囊性癌, 神经周围浸润, 实体型组织学模式, 局部复发, 综合治疗

Abstract: Objective To investigate the clinical characteristics, treatment strategies, and prognostic factors of adenoid cystic carcinoma (ACC) of the external auditory canal (EAC), and to provide evidence for optimizing surgical extent and adjuvant therapy. Methods A retrospective cohort study was conducted on 58 patients with pathologically confirmed ACC of the EAC treated in Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, between January 2001 and December 2021. All patients underwent surgical treatment, with some receiving adjuvant radiotherapy. The primary outcome was local recurrence, while secondary outcomes included overall survival (OS) and local recurrence-free survival (LRFS). Survival analysis was performed by the Kaplan-Meier method, and Cox regression models were used to identify risk factors for recurrence. Results The median follow-up time for the entire cohort was 6.27（3.25, 11.30）years. The 1-year, 3-year, and 5-year OS rates were 96.55%, 91.37%, and 89.66%. 43.10% of cases were classified as T4 stage at diagnosis, indicating advanced local progression. Local recurrence occurred in 23 patients (39.66%), and distant metastasis was observed in 28 patients (48.28%), with pulmonary metastasis accounting for 92.86% of cases. Multivariate analysis revealed that the solid histological pattern (HR=2.729, 95% CI: 1.025－7.226, P=0.044) and perineural invasion (PNI) (HR=9.891, 95% CI: 3.525－27.752, P<0.01) were independent risk factors for local recurrence. Conclusion ACC of the EAC is characterized by a high propensity for local recurrence and distant metastasis. The solid histological pattern and perineural invasion are critical prognostic determinants. Multimodal therapy (surgery combined with adjuvant radiotherapy) may improve clinical outcomes, and early diagnosis and intervention are pivotal for enhancing survival rates.

Key words: adenoid cystic carcinoma, perineural invasion, solid histological pattern, local recurrence, comprehensive treatment

中图分类号:

R762

武骏, 赵茜, 马廷耀, 杨国梁, 张姝晶, 赵玥, 刘懿萱, 陈晓红. 外耳道腺样囊性癌的临床特征及预后分析[J]. 首都医科大学学报, 2025, 46(3): 559-566.

Wu Jun, Zhao Xi, Ma Tingyao, Yang Guoliang, Zhang Shujing, Zhao Yue, Liu Yixuan, Chen Xiaohong. Clinical features and prognostic analysis of adenoid cystic carcinoma of the external auditory canal[J]. Journal of Capital Medical University, 2025, 46(3): 559-566.

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外耳道腺样囊性癌的临床特征及预后分析

Clinical features and prognostic analysis of adenoid cystic carcinoma of the external auditory canal

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