Morinière Sylvain, Périé Sophie, Lacau St Guily Jean
Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University Francois Rabelais, Bretonneau Hospital, 4 Bd Tonnellé, 37044, Tours Cedex 1, France.
Eur Arch Otorhinolaryngol. 2007 Oct;264(10):1231-7. doi: 10.1007/s00405-007-0351-8. Epub 2007 May 30.
Our aim was to report our experience in the management of malignant primary and non-primary parotid neoplasms and to compare the clinical presentations, the treatment modalities and the outcomes in these two groups. We performed a retrospective review of the clinical and surgical data contained in patient files. Between January 1995 and December 2004, 60 patients with malignant parotid tumors were admitted to our department. Two groups were isolated: a group of 42 patients with primary parotid malignancies (group 1) and a group of 18 patients with non-primary parotid malignancies (intra-parotid metastasis and parotid lymphoma), (group 2). We compared the preoperative data, the surgical procedures performed total parotidectomy (TP) versus superficial parotidectomy (SP), the need for sacrificing the facial nerve and postoperative facial nerve function in the two groups. Actuarial survival rates were calculated using the Kaplan-Meier method in combination with the Log Rank test for comparison of the results in the two groups. Preoperative clinical facial nerve impairment was significantly more frequent in group 1 (33%) as compared to group 2 (6%) (P = 0.023). A SP was performed in 15 patients in group 2 while a TP was performed in 37 patients in group 1. The facial nerve was completely or partially sacrificed in 17 cases in group 1 and in only one case in group 2 (P = 0.03). One month after surgery, 18 patients in group 1 had persistent facial nerve dysfunction compared to only one patient in group 2 (P = 0.004). In group 1, the overall 1, 3 and 5-year survival rates were, respectively, 94, 76 and 69%. In group 2, the respective survival rates were 84, 62 and 40% (P = 0.4). This study outlines the differences in clinical presentation, surgical management and outcomes in the two main groups of malignant parotid tumors. The prognosis of facial nerve function was better in non-primary parotid malignancies. SP was the standard surgical option in group 2 patients while a TP was performed in the majority of the patients in group 1. Except when melanoma or lymphoma were present (which require specific treatment), adjuvant radiotherapy had the same indications in both groups when the tumors were high-grade, AJCC stages III and IV or when they had positive margins or lymph node and facial nerve involvement.
我们的目的是报告我们在恶性原发性和非原发性腮腺肿瘤管理方面的经验，并比较这两组患者的临床表现、治疗方式及治疗结果。我们对患者病历中的临床和手术数据进行了回顾性分析。1995年1月至2004年12月期间，60例腮腺恶性肿瘤患者入住我科。分为两组：一组42例原发性腮腺恶性肿瘤患者（第1组），另一组18例非原发性腮腺恶性肿瘤患者（腮腺内转移瘤和腮腺淋巴瘤）（第2组）。我们比较了两组患者的术前数据、所施行的手术方式（全腮腺切除术[TP]与腮腺浅叶切除术[SP]）、面神经牺牲情况及术后面神经功能。采用Kaplan-Meier法结合Log Rank检验计算精算生存率，以比较两组结果。第1组术前临床面神经损伤发生率（33%）显著高于第2组（6%）（P = 0.023）。第2组15例患者施行SP，第1组37例患者施行TP。第1组17例患者面神经被完全或部分牺牲，而第2组仅1例（P = 0.03）。术后1个月，第1组18例患者存在持续性面神经功能障碍，而第2组仅1例（P = 0.004）。第1组患者总体1年、3年和5年生存率分别为94%、76%和69%。第2组相应生存率分别为84%、62%和40%（P = 0.4）。本研究概述了腮腺恶性肿瘤两大主要类型在临床表现、手术治疗及治疗结果方面的差异。非原发性腮腺恶性肿瘤患者面神经功能预后较好。SP是第2组患者的标准手术选择，而第1组大多数患者施行TP。除存在黑色素瘤或淋巴瘤（需要特殊治疗）外，当肿瘤为高级别、美国癌症联合委员会（AJCC）III期和IV期，或切缘阳性、有淋巴结及面神经受累时，两组辅助放疗的适应证相同。
