Ali Safina, Bryant Robert, Palmer Frank L, DiLorenzo Monica, Shah Jatin P, Patel Snehal G, Ganly Ian
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2015 Nov;22(12):4014-9. doi: 10.1245/s10434-015-4454-y. Epub 2015 Mar 6.
This study aimed to show the incidence of distant metastases (DM) in salivary gland cancer as well as the types of histology most commonly associated with it and to identify factors predictive of DM.
The study identified 301 patients who underwent surgery for cancer of the major salivary glands at Memorial Sloan-Kettering Cancer center between 1985 and 2009. Clinical, tumor, and treatment characteristics were recorded. Tumors were categorized as low-, intermediate-, and high-risk pathology based on histologic subtype and grade. Factors predictive of distant recurrence-free probability (DRFP) were determined by uni- and multivariable analyses.
The primary tumor was parotid in 266 patients (88 %), and 96 tumors (32 %) were clinical T3/T4. For 57 patients (18.9 %), DM developed with a 5-year DRFP of 72.7 %. The most common site of metastasis was the lung (50 %). The clinical predictors were male gender, cT4 stage, cN+ stage, and clinical overall stage. The multivariable analysis of clinical variables showed male gender (p = 0.018), cT4 stage (p < 0.001), and cN+ stage (p = 0.004) to be significant. The pathologic predictors were high-risk and high-grade pathology, vascular invasion, perineural invasion, positive margins, pT4 stage, pN+ stage, and overall stage. The multivariable analysis of pathologic variables showed high-grade pathology (p < 0.001), perineural invasion (p = 0.005), and pN+ stage (p = 0.002) to be significant.
Distant metastases developed in approximately 20 % of the patients with salivary gland cancer. The most common site of metastases was the lung. The significant predictors of DM were cT4, cN+, male gender, high-grade pathology, perineural invasion, and positive nodal disease.
本研究旨在显示涎腺癌远处转移（DM）的发生率、与之最常相关的组织学类型，并确定预测DM的因素。
该研究纳入了1985年至2009年间在纪念斯隆凯特琳癌症中心接受主要涎腺癌手术的301例患者。记录临床、肿瘤和治疗特征。根据组织学亚型和分级将肿瘤分为低、中、高风险病理类型。通过单变量和多变量分析确定预测远处无复发生存概率（DRFP）的因素。
266例患者（88%）的原发肿瘤位于腮腺，96例肿瘤（32%）为临床T3/T4期。57例患者（18.9%）发生DM，5年DRFP为72.7%。最常见的转移部位是肺（50%）。临床预测因素为男性、cT4期、cN+期和临床总体分期。临床变量的多变量分析显示男性（p = 0.018）、cT4期（p < 0.001）和cN+期（p = 0.004）具有显著性。病理预测因素为高风险和高级别病理、血管侵犯、神经周围侵犯、切缘阳性、pT4期、pN+期和总体分期。病理变量的多变量分析显示高级别病理（p < 0.001）、神经周围侵犯（p = 0.005）和pN+期（p = 0.002）具有显著性。
涎腺癌患者中约20%发生远处转移。最常见的转移部位是肺。DM的显著预测因素为cT4、cN+、男性、高级别病理、神经周围侵犯和阳性淋巴结疾病。
