Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06520–8040, USA.
Am J Clin Oncol. 2011 Feb;34(1):76-81. doi: 10.1097/COC.0b013e3181d26d45.
The effect of adjuvant radiation therapy (RT) on survival in patients with adenoid cystic carcinoma (ACC) is much debated. Studies with large numbers of patients and long follow-up are lacking in the literature.
We identified 2286 single-primary ACCs of the head and neck treated with surgery in the National Cancer Institute's surveillance, epidemiology, and end results database. The determinants of survival, including the effect of adjuvant RT, were analyzed with a Cox Proportional Hazards Model.
The overall 5-, 10-, 15-, 20-, and 25-year survival rates for patients receiving surgical resection were 77.3%, 59.6%, 44.9%, 35.0%, 25.5%, respectively. In the interval between 10 and 30 years after diagnosis, 111 patients died of ACC, and 137 died of all competing causes combined. Increasing stage caused a decrease in survival that was proportional over time. On multivariable analysis, distant metastasis, lymph node involvement, higher T classification, increasing age, and submandibular gland, or sinus/nasal cavity subsites were each independently associated with decreased overall and cause-specific survival. Adjuvant RT failed to improve overall or cause-specific survival.
Cause-specific survival continues to decline up to 30 years after diagnosis in ACC of the head and neck. In the interval between 10 and 30 years after diagnosis, patients are nearly as likely to die of ACC as from all competing causes combined. Certain clinicopathological factors are associated with decreased survival. There is no evidence of increased survival in patients receiving adjuvant RT.
辅助放疗（RT）对腺样囊性癌（ACC）患者生存的影响存在很大争议。文献中缺乏患者数量多且随访时间长的研究。
我们在国家癌症研究所的监测、流行病学和最终结果数据库中确定了 2286 例头颈部单一原发性 ACC 患者，这些患者接受了手术治疗。采用 Cox 比例风险模型分析了生存的决定因素，包括辅助 RT 的效果。
接受手术切除的患者的总 5 年、10 年、15 年、20 年和 25 年生存率分别为 77.3%、59.6%、44.9%、35.0%和 25.5%。在诊断后 10 至 30 年的间隔内，有 111 例患者死于 ACC，137 例患者死于所有竞争原因的组合。分期的增加导致生存时间成比例下降。多变量分析显示，远处转移、淋巴结受累、较高的 T 分类、年龄增加以及颌下腺或鼻窦/鼻腔亚部位与总生存率和特定原因生存率降低独立相关。辅助 RT 未能改善总体生存率或特定原因生存率。
头颈部 ACC 患者在诊断后 30 年内仍持续出现特定原因的生存率下降。在诊断后 10 至 30 年的间隔内，死于 ACC 的患者与死于所有竞争原因的患者比例几乎相等。某些临床病理因素与生存率降低相关。接受辅助 RT 的患者没有生存获益的证据。
