Department of Otolaryngology, University of Pittsburgh School of Medicine and Cancer Institute, Pittsburgh, PA 15213.
Departments of Otolaryngology Head & Neck Surgery, LSU Health Sciences Center, New Orleans, LA 70112.
Head Neck. 2011 Feb;33(2):225-231. doi: 10.1002/hed.21433.
The aim of this study, using a retrospective chart review as the primary study design, was to determine the relative contribution of clinicopathologic risk factors versus low- and high-risk grade histologic groups to assist management of primary parotid cancers.
In all, 168 primary parotid malignancies were treated surgically at a tertiary care center from 1982 to 2005. Of these, 115 patients with complete follow-up information were further analyzed. Pathologic updating and reclassification in 28% of cases enabled comparison of tumor histology or grade with current consensus criteria. Clinical outcomes of high- and low-risk histology and grade were compared with the influence of traditional clinicopathologic risk factors.
Of 115 cases, the male:female ratio was equal and the median age was 63 years (range, 15 to 89 years). Mucoepidermoid carcinoma (n = 28) was the most common histology. The median follow-up was 44 months (range, 0–278 months). Of low-risk histology patients who underwent neck dissection 40% had pN+ disease. The median time to recurrence was not reached for low-risk tumors, compared with 29 months for high-risk tumors (p = .0001). Interestingly, extracapsular spread (ECS) and margin status were independent prognostic factors and conferred significantly greater prognostic value than histologic grade risk group. Disease-free survival (DFS) and overall survival (OS) at 5 years for the entire cohort were 51% and 57%, respectively. Risk group was a strong independent predictor of OS but not DFS.
Risk group defined by histology and grade was associated with DFS. ECS and margin status were independent predictors of DFS. Inclusion of ECS and margin status substantially improved the prediction of disease recurrence, supporting elective neck dissection and postoperative radiotherapy for high-grade tumors or low-risk histologies with positive margins or ECS.
本研究采用回顾性图表回顾作为主要研究设计，旨在确定临床病理危险因素与低风险和高风险组织学组相对于原发性腮腺癌管理的相对贡献。
在 1982 年至 2005 年期间，在一家三级保健中心对 168 例原发性腮腺恶性肿瘤进行了手术治疗。其中，对 115 例具有完整随访信息的患者进行了进一步分析。在 28%的病例中进行了病理更新和重新分类，使肿瘤组织学或分级与当前的共识标准进行了比较。比较了高风险和低风险组织学和分级的临床结果，以及传统临床病理危险因素的影响。
在 115 例病例中，男女比例相等，中位年龄为 63 岁（范围，15 至 89 岁）。黏液表皮样癌（n = 28）是最常见的组织学类型。中位随访时间为 44 个月（范围，0 至 278 个月）。低风险组织学患者中，行颈清扫术的患者有 40%患有 pN+疾病。低风险肿瘤的中位复发时间未达到，而高风险肿瘤为 29 个月（p =.0001）。有趣的是，包膜外扩散（ECS）和边缘状态是独立的预后因素，比组织学分级风险组具有更大的预后价值。整个队列的 5 年无病生存率（DFS）和总生存率（OS）分别为 51%和 57%。风险组是 OS 的强独立预测因子，但不是 DFS。
通过组织学和分级定义的风险组与 DFS 相关。ECS 和边缘状态是 DFS 的独立预测因子。包括 ECS 和边缘状态可以大大提高疾病复发的预测，支持对高级别肿瘤或低风险组织学伴阳性边缘或 ECS 进行选择性颈清扫术和术后放疗。
