Liu Zhonglong, Fang Zao, Dai Tianguo, Zhang Chenping, Sun Jian, He Yue
Department of Oromaxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhi-zao-ju Road No 639, Shanghai 200011, China.
J Craniomaxillofac Surg. 2015 Jul;43(6):751-7. doi: 10.1016/j.jcms.2015.03.040. Epub 2015 Apr 11.
Extensive studies have been conducted to analyze adenoid cystic carcinoma (ACC) in the head and neck region. No research has been published focusing on ACC patients with cervical lymph node (LN) metastasis. The aims of current investigation were to summarize the clinical characteristics of ACC patients with LN metastasis (ACC-LNM) and to identify prognostic factors for tumor-related outcomes.
A retrospective review was conducted with respect to ACC patients with nodal involvement between 2000 and 2013. The clinical variables and outcomes of these special cases were recorded and further analyzed. Metastasis-free survival and overall survival rate were calculated using the Kaplan-Meier method, and the log-rank test and Cox regression analysis were applied to identify the prognostic factors.
A total of 47 patients (34 male and 13 female) 32-77 years of age (mean: 54.6 years; median: 54 years) were analyzed in the current protocol. The recurrence-free survival (RFS), distant metastasis-free survival (MFS), and overall survival (OS) rate in all patients were 90.1%, 55.6%, and 60.1%, respectively. In univariate analysis, T stage, positive LN ratio, LN-involved section, and extracapsular spread were strongly associated with poorer MFS rate. The predictive roles of LN-involved section and surgical margin on the OS rate were also identified. In multivariate analysis, positive LN ratio and surgical margin were predictors for MFS and OS rate, respectively.
Positive LN ratio was strongly associated with distant metastasis. Comprehensive treatment should be performed in ACC patients with higher positive LN ratios. In addition, ideal surgical margin should be achieved to acquire better overall survival rate.
已开展大量研究分析头颈部腺样囊性癌（ACC）。尚未发表聚焦于伴有颈部淋巴结（LN）转移的ACC患者的研究。本研究的目的是总结伴有LN转移的ACC患者（ACC-LNM）的临床特征，并确定肿瘤相关预后的预测因素。
对2000年至2013年间有淋巴结受累的ACC患者进行回顾性研究。记录并进一步分析这些特殊病例的临床变量和预后。采用Kaplan-Meier法计算无转移生存率和总生存率，并应用对数秩检验和Cox回归分析确定预后因素。
本研究方案共分析了47例患者（男性34例，女性13例），年龄32至77岁（平均：54.6岁；中位数：54岁）。所有患者的无复发生存率（RFS）、无远处转移生存率（MFS）和总生存率（OS）分别为90.1%、55.6%和60.1%。单因素分析中，T分期、阳性LN比例、LN受累节段和包膜外扩散与较差的MFS率密切相关。还确定了LN受累节段和手术切缘对OS率的预测作用。多因素分析中，阳性LN比例和手术切缘分别是MFS和OS率的预测因素。
阳性LN比例与远处转移密切相关。对于阳性LN比例较高的ACC患者应进行综合治疗。此外，应实现理想的手术切缘以获得更好的总生存率。
