复发性和转移性腺样囊性癌的临床治疗后死亡率风险。
Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma.
机构信息
Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA.
出版信息
J Otolaryngol Head Neck Surg. 2018 Apr 25;47(1):28. doi: 10.1186/s40463-018-0273-z.
BACKGROUND
Management of locoregional recurrence (LRR) and distant metastasis (DM) in adenoid cystic carcinoma (ACC) is guided by limited data. We investigated mortality risks in patients diagnosed and treated for recurrent ACC.
METHODS
A retrospective review of ACC patients treated from 1989 to 2016 identified 36 patients with LRR or DM. High-risk disease was defined as skull base involvement (for LRR) or International Registry of Lung Metastases Group III/IV or extrapulmonary site of metastasis (for DM). Kaplan-Meier method, log-rank tests, and Cox proportional hazards were used for time-to-event analysis.
RESULTS
Among 20 LRR and 16 DM patients, the median times to recurrence were 51 and 50 months, respectively. The median follow-up post-recurrence was 37.5 months (interquartile range (IQR)16.5-56.5). Post-recurrence 3-year overall survival (OS) was 78.5%, 73.3% for LRR and 85.1% for DM (p = 0.62). High-risk recurrences were associated with worse 3-year OS (68.8% for high-risk and 92.3% for low-risk, χ2 = 10.4, p = 0.001). Among LRR patients, 90% had surgery as part of their treatment. Multimodality therapy, age, and histopathologic features (size, margins, solid histology, lymphovascular or perineural invasion) were not associated with PFS or OS. High-risk LRR was the only variable associated with OS (χ2 = 5.9, p = 0.01). Among DM patients, six were initially managed with observation and ten received surgery, RT, or systemic therapy. Upfront therapy was not associated with improved PFS or OS. High-risk DM was the only variable associated with OS (χ2 = 4.7, p = 0.03).
CONCLUSIONS
High-risk LRR and DM were associated with decreased 3-year OS. More effective therapies are needed for high-risk ACC recurrences.
背景
局部区域复发（LRR）和远处转移（DM）的腺样囊性癌（ACC）管理依据的是有限的数据。我们研究了诊断和治疗复发性 ACC 患者的死亡率风险。
方法
对 1989 年至 2016 年治疗的 ACC 患者进行回顾性分析，确定了 36 例 LRR 或 DM 患者。高危疾病定义为颅底受累（LRR）或国际肺转移登记处（IRM）分组 III/IV 或肺外转移部位（DM）。使用 Kaplan-Meier 方法、对数秩检验和 Cox 比例风险进行生存时间分析。
结果
在 20 例 LRR 和 16 例 DM 患者中，复发时间的中位数分别为 51 个月和 50 个月。复发后中位随访时间为 37.5 个月（四分位间距（IQR）16.5-56.5）。复发后 3 年总生存率（OS）为 78.5%，LRR 为 73.3%，DM 为 85.1%（p=0.62）。高危复发与 3 年 OS 较差相关（高危为 68.8%，低危为 92.3%，χ2=10.4，p=0.001）。在 LRR 患者中，90%的患者接受了手术治疗。多模式治疗、年龄和组织病理学特征（大小、边缘、实体组织学、淋巴血管或神经周围浸润）与 PFS 或 OS 无关。高危 LRR 是唯一与 OS 相关的变量（χ2=5.9，p=0.01）。在 DM 患者中，6 例患者最初接受观察治疗，10 例患者接受手术、放疗或全身治疗。初始治疗与 PFS 或 OS 改善无关。高危 DM 是唯一与 OS 相关的变量（χ2=4.7，p=0.03）。
结论
高危 LRR 和 DM 与 3 年 OS 降低相关。需要为高危 ACC 复发提供更有效的治疗方法。
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