Qian Kai, Di Lu, Guo Kai, Zheng Xiaoke, Ji Qinghai, Wang Zhuoying
Resident, Departments of Head and Neck Surgery and Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
Resident, Departments of Oncology and Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
J Oral Maxillofac Surg. 2018 Jul;76(7):1578-1586. doi: 10.1016/j.joms.2018.01.033. Epub 2018 Feb 19.
Salivary duct carcinoma (SDC) is an aggressive malignancy that is not yet fully understood. We designed the present retrospective study to investigate the factors affecting the prognosis of SDC and the effects of adjuvant therapies on the clinical outcomes of patients.
Patients with SDC treated surgically from 2006 to 2016 were enrolled in the present retrospective cohort study. The demographic data, clinical pathologic characteristics, and follow-up results were recorded. The prognostic indicators of overall survival (OS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) were analyzed using the Kaplan-Meier method and the Cox proportional hazard model.
The study sample included 66 patients, most of whom were male (81.8%). The 5-year OS, LRFFS, and DMFS for all patients was 52.5%, 63.9%, and 51.3%, respectively. Univariate analysis showed that stage N2-N3, lymph node involvement of levels IV and V, 8 or more positive lymph nodes, and extranodal extension were all negative prognostic indicators for OS. The only significant indicator on multivariate analysis was the number of positive lymph nodes. Multivariate analysis revealed that extracapsular invasion and no adjuvant radiotherapy were risk factors for LRFFS. In contrast, lesions involving both glands and 8 or more positive lymph nodes were prognostic factors for DMFS. Further subgroup analysis showed that radiotherapy was only useful for patients with locally advanced lesions for local control.
Cervical lymph node metastatic status is an important factor in predicting the prognosis of SDC patients. Adjuvant radiotherapy is useful for local control, especially for patients with stage T4 disease but does not benefit OS and DMFS.
涎腺导管癌（SDC）是一种侵袭性恶性肿瘤，目前尚未完全了解。我们设计了本回顾性研究，以调查影响SDC预后的因素以及辅助治疗对患者临床结局的影响。
本回顾性队列研究纳入了2006年至2016年接受手术治疗的SDC患者。记录人口统计学数据、临床病理特征和随访结果。采用Kaplan-Meier法和Cox比例风险模型分析总生存（OS）、局部区域无复发生存（LRFFS）和远处无转移生存（DMFS）的预后指标。
研究样本包括66例患者，其中大多数为男性（81.8%）。所有患者的5年OS、LRFFS和DMFS分别为52.5%、63.9%和51.3%。单因素分析显示，N2-N3期、IV和V级淋巴结受累、8个或更多阳性淋巴结以及结外扩展均为OS的不良预后指标。多因素分析中唯一显著的指标是阳性淋巴结数量。多因素分析显示，包膜外侵犯和未接受辅助放疗是LRFFS的危险因素。相比之下，累及双侧腺体和8个或更多阳性淋巴结的病变是DMFS的预后因素。进一步的亚组分析表明，放疗仅对局部晚期病变患者的局部控制有用。
颈部淋巴结转移状态是预测SDC患者预后的重要因素。辅助放疗对局部控制有用，尤其是对T4期疾病患者，但对OS和DMFS无益处。
