Girelli Lara, Locati Laura, Galeone Carlotta, Scanagatta Paolo, Duranti Leonardo, Licitra Lisa, Pastorino Ugo
Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Medical Oncology Unit/Head and Neck Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Oral Oncol. 2017 Feb;65:114-118. doi: 10.1016/j.oraloncology.2016.10.018. Epub 2016 Oct 26.
Adenoid cystic carcinoma (ACC) of salivary glands is characterized by long-term distant metastasis, most commonly in lungs. No agreement has been reached about the role of surgical treatment of pulmonary lesions. We evaluated the long-term results of lung metastasectomy for ACC in order to identify factors that should be taken into account in selecting patients eligible for surgery and treatment planning.
A retrospective study was conducted on 109 patients selected from our institutional experience and from the International Registry of Lung Metastases. Survival was calculated by Kaplan-Meier estimate and prognostic factors endowed with a predictive power for most other metastatic cancers were investigated.
The cumulative survival was 66.8% at 5years and 40.5% at 10years. In patients with a disease-free interval (DFI) greater than 36months, the overall survival was 76.5% at 5years. Survival in case of complete surgical resection was 69.5% at 5years. Multivariate analysis confirmed DFI and completeness of resection resulted in the best prognostic variables.
Lung metastasectomy should be considered as a therapeutic option to achieve local control of disease when 2 conditions are met: (1) complete surgical resection is feasible and (2) the time to pulmonary relapse after primary tumor treatment is greater than 36months. Symptomatic benefits of an incomplete lung resection in slow-growing tumors such as ACC remain uncertain. The turning point in the management of disseminated cancers will be clarified with biological profiling of ACC and the development of targeted therapies.
涎腺腺样囊性癌（ACC）的特点是长期发生远处转移，最常见于肺部。对于肺部病变的外科治疗作用尚未达成共识。我们评估了肺转移瘤切除术治疗ACC的长期结果，以确定在选择适合手术的患者和制定治疗计划时应考虑的因素。
对从我们机构经验以及国际肺转移瘤登记处选取的109例患者进行了一项回顾性研究。采用Kaplan-Meier法估算生存率，并研究了对大多数其他转移性癌症具有预测能力的预后因素。
5年累计生存率为66.8%，10年为40.5%。无病间期（DFI）大于36个月的患者，5年总生存率为76.5%。手术完全切除患者的5年生存率为69.5%。多因素分析证实，DFI和切除的完整性是最佳的预后变量。
当满足以下两个条件时，肺转移瘤切除术应被视为实现疾病局部控制的一种治疗选择：（1）可行手术完全切除；（2）原发肿瘤治疗后至肺部复发的时间大于36个月。对于生长缓慢的肿瘤如ACC，不完全肺切除的症状改善益处仍不确定。随着ACC的生物学特征分析和靶向治疗的发展，播散性癌症治疗的转折点将得以明确。
