Klussmann J P, Ponert T, Mueller R P, Dienes H P, Guntinas-Lichius O
Clinic of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, D-50924 Köln, Germany.
Department of Radiation Oncology, University of Cologne, Cologne, D-50924 Köln, Germany.
Eur J Surg Oncol. 2008 Aug;34(8):932-937. doi: 10.1016/j.ejso.2008.02.004. Epub 2008 Mar 21.
To assess the metastatic topography of intraparotideal and neck lymph nodes in parotid cancer and its influence on tumour recurrence and survival.
The lymph node spread of 142 patients with primary parotid carcinoma treated from 1986 to 2006 was analysed. Disease-free survival (DFS) and overall survival (OS) were calculated. The role of the metastatic pattern as prognostic factors were univariately and multivariately analysed.
A lateral, total or radical parotidectomy was performed in 19, 80 and 43 patients, respectively. A radical/radical-modified or selective neck dissection was performed in 68 and 74 patients, respectively. Eighty-seven neck dissection specimens were negative (pN0). Twelve patients had intraparotideal and cervical lymph node involvement (pPar+/pN+). In 24 patients only intraparotideal metastases were detected (pPar+/pN0). 19 patients only had cervical nodal involvement (pPar-/pN+). Twenty-five patients had occult locoregional lymph metastases (cN0/pN+). The median follow-up was 24.4 months. The disease-free survival rate was 81% at 5 years, and 62% at 10 years. By univariate analysis, R+ (p=0.001), pT (p=0.019), lymphangiosis carcinomatosa (p=0.019), pN+ (p=0.042), and extracapsular spread (p=0.046) were prognostic for disease-free survival. Multivariate analysis revealed R+ as independent risk factor (p=0.046). In pN+ patients, involvement of parotid lymph nodes (p=0.013), nodes in neck level I (p<0.0001) and IV (p=0.005) were univariate risk factors. Multivariate analysis showed lymph node metastases in level I as independent risk factor (p=0.022).
Total parotidectomy and radical-modified neck dissection is recommended as surgical treatment of parotid cancer and should be analysed in a prospective trial.
评估腮腺癌患者腮腺内及颈部淋巴结的转移部位及其对肿瘤复发和生存的影响。
分析了1986年至2006年期间接受治疗的142例原发性腮腺癌患者的淋巴结转移情况。计算无病生存期（DFS）和总生存期（OS）。对转移模式作为预后因素的作用进行单因素和多因素分析。
分别对19例、80例和43例患者进行了外侧、全腮腺或根治性腮腺切除术。分别对68例和74例患者进行了根治性/改良根治性或选择性颈部淋巴结清扫术。87例颈部淋巴结清扫标本为阴性（pN0）。12例患者腮腺内及颈部淋巴结受累（pPar+/pN+）。24例患者仅检测到腮腺内转移（pPar+/pN0）。19例患者仅颈部淋巴结受累（pPar-/pN+）。25例患者有隐匿性局部区域淋巴结转移（cN0/pN+）。中位随访时间为24.4个月。5年无病生存率为81%，10年为62%。单因素分析显示，R+（p = 0.001）、pT（p = 0.019）、淋巴管癌栓（p = 0.019）、pN+（p = 0.042）和包膜外扩散（p = 0.046）是无病生存的预后因素。多因素分析显示R+是独立危险因素（p = 0.046）。在pN+患者中，腮腺淋巴结受累（p = 0.013）、Ⅰ区淋巴结（p < 0.0001）和Ⅳ区淋巴结（p = 0.005）是单因素危险因素。多因素分析显示Ⅰ区淋巴结转移是独立危险因素（p = 0.022）。
推荐行全腮腺切除术和改良根治性颈部淋巴结清扫术作为腮腺癌的手术治疗方法，应在前瞻性试验中进行分析。
