Szewczyk Mateusz, Golusiński Paweł, Pazdrowski Jakub, Pieńkowski Piotr, Marszałek Sławomir, Sygut Jacek, Golusiński Wojciech
Department of Head and Neck Surgery. Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland.
Department of Biology and Environmental Studies, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland.
Rep Pract Oncol Radiother. 2018 Jul-Aug;23(4):260-265. doi: 10.1016/j.rpor.2018.05.004. Epub 2018 Jun 23.
The purpose of the study was to publish our experience of salivary gland cancer treatment with large number of patients treated at a single institution.
Salivary gland cancers are rare tumors of the head and neck representing about 5% of cancers in that region and about 0.5% of all malignancies. Due to the rarity of the disease, most of the studies regarding treatment outcome consist of low number of patients, thus making it difficult to draw conclusions.
115 patients with primary salivary gland cancer were included in a retrospective study. The subsites of tumor were the parotid gland (58% patients), submandibular gland (19%) and minor salivary glands (23%). All patients underwent primary surgical resection. The following were collected: age, stage of the disease, T status, N status, grade of tumor, perineurial invasion, lymphovascular invasion, extracapsular spread, final histological margin status and postoperative treatment. Details of local, regional or distant recurrence, disease free survival and overall survival were included.
The majority (65%) of patients presented in early stage, T1 and T2 tumors. 81% of patients were N0. Free surgical margins were achieved in 18% of patients, close in 28% patients and positive surgical margins in 54% (62) patients. Factors that significantly increased the risk of recurrence: T stage ( = 0.0006); N-positive status ( < 0.0001); advanced stage of the disease ( < 0.0001); high grade of tumor ( = 0.0007); PNI ( = 0.0061); LVI ( = 0.0022); ECS ( = 0.0136); positive surgical margins ( = 0.0022). On multivariate analysis, high grade of tumor and positive surgical margins remained significant independent adverse factors for recurrence formation.
This report shows a single institution results of oncological treatment in patients with malignant salivary gland tumors, where positive surgical margins strongly correlate with patients' worse outcome. Whether to extend the procedure, which very often requires sacrificing the nerve is still a question of debate.
本研究的目的是公布我们在单一机构治疗大量涎腺癌患者的经验。
涎腺癌是头颈部的罕见肿瘤，约占该区域癌症的5%，占所有恶性肿瘤的0.5%。由于该疾病罕见，大多数关于治疗结果的研究患者数量较少，因此难以得出结论。
115例原发性涎腺癌患者纳入回顾性研究。肿瘤的亚部位为腮腺（58%的患者）、下颌下腺（19%）和小涎腺（23%）。所有患者均接受了初次手术切除。收集了以下信息：年龄、疾病分期、T状态、N状态、肿瘤分级、神经周围侵犯、淋巴管侵犯、包膜外扩散、最终组织学切缘状态和术后治疗。包括局部、区域或远处复发、无病生存期和总生存期的详细信息。
大多数（65%）患者为早期，即T1和T2肿瘤。81%的患者为N0。18%的患者实现了切缘阴性，28%的患者切缘接近，54%（62例）患者切缘阳性。显著增加复发风险的因素：T分期（P = 0.0006）；N阳性状态（P < 0.0001）；疾病晚期（P < 0.0001）；肿瘤高级别（P = 0.0007）；神经周围侵犯（P = 0.0061）；淋巴管侵犯（P = 0.0022）；包膜外扩散（P = 0.0136）；切缘阳性（P = 0.0022）。多因素分析显示，肿瘤高级别和切缘阳性仍然是复发形成的显著独立不良因素。
本报告展示了单一机构对恶性涎腺肿瘤患者进行肿瘤治疗的结果，其中切缘阳性与患者较差的预后密切相关。是否扩大手术范围（这通常需要牺牲神经）仍是一个有争议的问题。
