Bron Luc P, Traynor Sean J, McNeil Edward B, O'Brien Christopher J
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Australia.
Laryngoscope. 2003 Jun;113(6):1070-5. doi: 10.1097/00005537-200306000-00029.
OBJECTIVES/HYPOTHESIS: Parotid malignancy may develop as a primary cancer of salivary tissue or by metastatic involvement of parotid lymph nodes. The aim of the study was to compare the clinical behavior of primary and metastatic parotid cancers by analyzing patterns of treatment failure and clinical outcomes.
Retrospective review of clinical and pathologic data prospectively accessioned onto a computerized database.
A prospectively documented series of 232 parotidectomies carried out for treatment of cancer from 1988 to 1999 was reviewed. There were 177 male and 55 female patients with a median age of 65 years (age range, 17-97 y). Median follow-up time was 4 years. Pathological groups included 54 patients with primary parotid cancer, 101 with metastatic cutaneous squamous cell carcinoma, 69 with metastatic melanoma, and 8 with other metastatic cancers.
Neck nodes were clinically positive in 12 patients with primary cancer, 24 patients with squamous cell carcinoma, 16 with melanoma, and 2 with other metastatic malignancies. Conservative parotidectomy, preserving the main trunk of the facial nerve, was performed in 185 patients, and 47 patients had a radical parotidectomy sacrificing the facial nerve. There were 54 therapeutic and 110 elective neck dissections. Adjuvant radiotherapy was given to 39 patients with primary cancer, 86 with squamous cell carcinoma, 50 with melanoma, and 8 in the other metastatic group (78% of the patients in the series). Local control rates at 5 years in the four groups were 86%, 75%, 94%, and 100%, respectively (P <.01). Survival rates at 5 years were 77%, 65%, 46%, and 56%, respectively (P <.01).
The pattern of parotid malignancy is unique in Australia because of the high incidence of skin cancer, which can metastasize to the parotid gland. Metastatic cutaneous malignancy predominates. The pattern of failure and outcome varied depending on histological findings. Local failure occurred most often in metastatic squamous cell carcinoma, whereas patients with melanoma had the highest incidence of distant spread.
目的/假设：腮腺恶性肿瘤可能原发于涎腺组织，也可能是腮腺淋巴结发生转移所致。本研究旨在通过分析治疗失败模式和临床结果，比较原发性和转移性腮腺癌的临床行为。
对前瞻性录入计算机数据库的临床和病理数据进行回顾性分析。
回顾1988年至1999年期间为治疗癌症而行腮腺切除术的232例患者的前瞻性记录资料。其中男性177例，女性55例，中位年龄65岁（年龄范围17 - 97岁）。中位随访时间为4年。病理分组包括54例原发性腮腺癌患者、101例转移性皮肤鳞状细胞癌患者、69例转移性黑色素瘤患者和8例其他转移性癌症患者。
12例原发性癌症患者、24例鳞状细胞癌患者、16例黑色素瘤患者和2例其他转移性恶性肿瘤患者的颈部淋巴结临床检查呈阳性。185例患者行保留面神经主干的保守性腮腺切除术，47例患者行牺牲面神经的根治性腮腺切除术。进行了54例治疗性颈部清扫术和110例选择性颈部清扫术。39例原发性癌症患者、86例鳞状细胞癌患者、50例黑色素瘤患者和8例其他转移性癌症患者接受了辅助放疗（占本系列患者的78%）。四组患者5年局部控制率分别为86%、75%、94%和100%（P <.01）。5年生存率分别为77%、65%、46%和56%（P <.01）。
由于皮肤癌发病率高，可转移至腮腺，澳大利亚腮腺恶性肿瘤的模式具有独特性。转移性皮肤恶性肿瘤占主导。失败模式和结果因组织学检查结果而异。局部失败最常发生在转移性鳞状细胞癌中，而黑色素瘤患者远处转移发生率最高。
