Shigetomi Seiji, Imanishi Yorihisa, Shimoda Masayuki, Tomita Toshiki, Ozawa Hiroyuki, Sakamoto Koji, Fujii Ryoichi, Habu Noboru, Otsuka Kuninori, Yamashita Taku, Fujii Masato, Ogawa Kaoru
Nihon Jibiinkoka Gakkai Kaiho. 2014 May;117(5):658-65. doi: 10.3950/jibiinkoka.117.658.
We retrospectively reviewed the records of the 30 patients with adenoid cystic carcinoma of the head and neck (ACCHN) who had undergone initial treatment in the Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine between 1988 and 2007. The primary tumor site was the parotid gland in 10 patients and the submandibular gland in 4 patients, which account for about a half of the subjects. Thirty patients underwent surgical resection with curative intent as the primary treatment, of which 10 patients had post-operative radiotherapy. The 5-and 10-year disease-specific survival (DSS) was 73.9% and 62.4%, respectively, whereas the 5-and 10-year disease-free survival (DFS) was 64.3% and 59.7%, respectively. A univariate analysis revealed that DSS was significantly correlated with perineural invasion (p = 0.010) and lymphatic invasion (p = 0.036), while DFS was significantly correlated with higher T-stage (p = 0.044), a positive surgical margin (p = 0.012) and perineural invasion (p = 0.019). A multivariate analysis demonstrated that perineural invasion (p = 0.034, risk ratio = 9.530) was the independent prognostic factor for DSS, whereas for DFS it was a positive surgical margin (p = 0.038, risk ratio = 8.897). The histological grade classification, defined specifically for ACC, showed no correlation with the survival. Extended resection with wider margin and additional resection in cases with positive margin may improve treatment results, however, surgical resection alone can prevent neither the development of local recurrence mainly attributed to undetectable perineural invasion, nor that of delayed distant metastasis. Therefore, the roles of adjuvant radiotherapy and effective systemic therapies are also significant in ACCHN, although a reliable regimen for the latter has not yet been established. Development of a personalized strategy for the adjuvant therapy, which should be based on the accurate prediction of the long-term prognosis in combination with dependable molecular biomarkers, would be indispensable in the future to improve the clinical outcome of the patients with ACCHN.
我们回顾性分析了1988年至2007年间在庆应义塾大学医学院耳鼻咽喉头颈外科接受初始治疗的30例头颈部腺样囊性癌（ACCHN）患者的病历。原发肿瘤部位在10例患者中为腮腺，4例患者中为颌下腺，约占研究对象的一半。30例患者接受了以治愈为目的的手术切除作为主要治疗方法，其中10例患者术后接受了放疗。5年和10年的疾病特异性生存率（DSS）分别为73.9%和62.4%，而5年和10年的无病生存率（DFS）分别为64.3%和59.7%。单因素分析显示，DSS与神经周侵犯（p = 0.010）和淋巴侵犯（p = 0.036）显著相关，而DFS与更高的T分期（p = 0.044）、手术切缘阳性（p = 0.012）和神经周侵犯（p = 0.019）显著相关。多因素分析表明，神经周侵犯（p = 0.034，风险比 = 9.530）是DSS的独立预后因素，而对于DFS，手术切缘阳性（p = 0.038，风险比 = 8.897）是独立预后因素。专门为腺样囊性癌定义的组织学分级分类与生存率无关。扩大切缘的扩大切除术以及切缘阳性病例的额外切除术可能会改善治疗效果，然而，单纯手术切除既不能预防主要归因于难以检测到的神经周侵犯的局部复发的发生，也不能预防延迟远处转移的发生。因此，辅助放疗和有效的全身治疗在ACCHN中也具有重要作用，尽管后者可靠的治疗方案尚未确立。基于准确预测长期预后并结合可靠的分子生物标志物制定个性化的辅助治疗策略，对于未来改善ACCHN患者的临床结局将是必不可少的。
