Sakamoto Kikuo, Chijiwa Hideki, Miyajima Yoshimi, Umeno Hirohito, Nakashima Tadashi
Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka.
Nihon Jibiinkoka Gakkai Kaiho. 2006 Feb;109(2):103-11. doi: 10.3950/jibiinkoka.109.103.
The clinical features of 74 patients (39 men, 35 women; mean age, 62 years) with malignant parotid tumors were retrospectively investigated. According to the TNM Classification, 4 patients were classified as T1, 9 as T2, 6 as T3, and 55 as T4. Fifty cases were staged as N0, 9 as N1, 14 as N2 and 1 as N3. Tumors located in both lobes of the parotid gland were the most frequent type of tumor (49%). Twenty-four percent of the 74 patients exhibited facial nerve palsy before treatment. Facial palsy was found predominantly in cases with a higher T classification or with deep lobe occupation. Histopathologically, sixteen tumor types were observed; mucoepidermoid carcinoma was the most common. The overall five-year and ten-year survival rates determined using the Kaplan-Meier method were 65% and 61%. The factors influencing a poor outcome were T4 classification (p=0.0189), an N+ stage (p<0.0001), and facial palsy (p<0.0001). As for the major histopathologic types, the five-year survival rates were 69% for mucoepidermoid carcinoma, 48% for adenocarcinoma, 71% for adenoid cystic carcinoma, and 100% for acinic cell carcinoma and malignant mixed tumor. With respect to the treatment modality, patients who were classified as T1 or T2 and whose tumors were located in the superficial lobe without facial nerve invasion could be satisfactorily treated with only a superficial lobectomy conserving the facial nerve. A total parotidectomy with total removal of the facial nerve seemed necessary for T3 and T4 cases, especially those with adenocarcinoma or mucoepidermoid carcinoma. Modified neck dissection may be necessary for N0 cases, especially those with adenocarcinoma, adenoid cystic carcinoma or undifferentiated carcinoma. Nerve grafting after total nerve resection is recommended for a better quality of life.
对74例（39例男性，35例女性；平均年龄62岁）腮腺恶性肿瘤患者的临床特征进行了回顾性研究。根据TNM分类，4例为T1期，9例为T2期，6例为T3期，55例为T4期。50例为N0期，9例为N1期，14例为N2期，1例为N3期。位于腮腺两叶的肿瘤是最常见的肿瘤类型（49%）。74例患者中有24%在治疗前出现面神经麻痹。面神经麻痹主要见于T分级较高或深叶受累的病例。组织病理学上，观察到16种肿瘤类型；黏液表皮样癌最为常见。采用Kaplan-Meier法确定的总体五年和十年生存率分别为65%和61%。影响预后不良的因素为T4分级（p=0.0189）、N+分期（p<0.0001）和面神经麻痹（p<0.0001）。至于主要组织病理学类型，黏液表皮样癌的五年生存率为69%，腺癌为48%，腺样囊性癌为71%，腺泡细胞癌和恶性混合瘤为100%。关于治疗方式，对于分类为T1或T2且肿瘤位于浅叶且无面神经侵犯的患者，仅行保留面神经的浅叶切除术即可得到满意治疗。对于T3和T4病例，尤其是腺癌或黏液表皮样癌患者，似乎需要行全腮腺切除术并完全切除面神经。对于N0病例，尤其是腺癌、腺样囊性癌或未分化癌患者，可能需要行改良颈清扫术。建议在完全切除神经后进行神经移植以提高生活质量。
