Renehan A G, Gleave E N, Slevin N J, McGurk M
Department of Surgery, Christie Hospital NHS Trust, Manchester, UK.
Br J Cancer. 1999 Jun;80(8):1296-300. doi: 10.1038/sj.bjc.6990501.
One hundred and three patients with primary parotid cancer treated surgically at the Christie Hospital, Manchester (1952-1992), were analysed to assess the influence on survival of prognostic and treatment-related factors. Thirty-seven patients were treated by surgery alone (SG), 66 received post-operative radiation (SG+RT). Median follow-up was 12 years, minimum 5 years. The 10-year disease-specific survival rates for stage I, II and III/IV were 96%, 61% and 17% respectively (P < 0.0001). The various histological types segregated into three survival patterns: low-, intermediate-and high-grade with 10-year survival rates of 93%, 41% and 50% respectively (P < 0.0001). On multivariate analysis, the factors influencing risk of cancer death in order of importance were: tumour size > 4 cm (P < 0.001), presence of nodes (P = 0.001), histology of adenoid cystic carcinoma (P = 0.01), high-tumour grade (P = 0.02) and perineural involvement (P = 0.01). Neither the extent of surgery nor the operator influenced outcome. Overall, adjuvant RT significantly reduced locoregional recurrence (SG+RT 15% vs SG 43%; P = 0.002) but not survival, although on subanalysis, there was a trend to improved survival with large cancers and high-grade tumours. Long-term survival is determined primarily by tumour characteristics, namely clinical stage and grade. Post-operative RT contributes significantly to locoregional control and probably confers some survival advantage in high-risk patients.
对1952年至1992年在曼彻斯特克里斯蒂医院接受手术治疗的103例原发性腮腺癌患者进行分析，以评估预后和治疗相关因素对生存的影响。37例患者仅接受手术治疗（单纯手术组），66例接受术后放疗（手术+放疗组）。中位随访时间为12年，最短5年。I期、II期和III/IV期的10年疾病特异性生存率分别为96%、61%和17%（P<0.0001）。不同组织学类型分为三种生存模式：低级别、中级和高级别，10年生存率分别为93%、41%和50%（P<0.0001）。多因素分析显示，影响癌症死亡风险的因素按重要性排序为：肿瘤大小>4 cm（P<0.001）、有淋巴结转移（P=0.001）、腺样囊性癌组织学类型（P=0.01）、肿瘤高级别（P=0.02）和神经周围侵犯（P=0.01）。手术范围和手术医生均不影响预后。总体而言，辅助放疗显著降低了局部区域复发率（手术+放疗组为15%，单纯手术组为43%；P=0.002），但未提高生存率，不过亚组分析显示，对于大肿瘤和高级别肿瘤，放疗有改善生存的趋势。长期生存主要取决于肿瘤特征，即临床分期和分级。术后放疗对局部区域控制有显著贡献，可能对高危患者有一定的生存优势。
