鼻腔・副鼻腔の腸管型腺癌：単一施設経験からの予後および有害な予後因子

Sinonasal intestinal-type adenocarcinoma (ITAC) is a rare malignancy with high recurrence rates and significant morbidity. This study evaluates survival outcomes and prognostic factors-particularly the impact of tumor stage (pT category), histologic grade, and resection margins-in a contemporary institutional series.

A retrospective analysis included 30 patients treated for histologically confirmed sinonasal ITAC at a single centre from July 2010 to July 2024. Patient demographics, tumor characteristics, treatment strategies (including surgical approach and perioperative therapies), and outcomes were reviewed. Kaplan-Meier analyses were used to estimate overall (OS), disease-specific (DSS), and disease-free survival (DFS).

The study cohort comprised predominantly male patients (86.7%), with a mean age of 66 years. Advanced disease (pT3 and pT4) occurred in 66.7% of patients. The median follow-up was 53 months. Five-year OS was 58.6%, DSS 75.3%, and DFS 65.3%. Early-stage tumors (pT1 and pT2) demonstrated superior outcomes, achieving 100% five-year OS and DSS compared to 41.7% OS and 62.9% DSS for advanced stages (p < 0.05).

Pathological T category remains a key prognostic determinant in sinonasal ITAC. Endoscopic resection, including transnasal craniectomy when necessary, coupled with risk-adapted radiotherapy, yields favorable survival outcomes even in advanced cases.