Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Pathology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Oral Oncol. 2019 Feb;89:144-149. doi: 10.1016/j.oraloncology.2019.01.003. Epub 2019 Jan 12.
In parotid gland cancer (PGC), it is not clear whether facial weakness always reflects tumor invasion of the facial nerve (FN) requiring nerve resection. The aims of this study were to evaluate oncological and functional outcomes in patients with PGC and pre-treatment facial weakness, and to analyze local tumor invasion of the FN.
The clinical outcomes of patients (n = 45) with PGC and pretreatment facial weakness were retrospectively analyzed. Patients had undergone 1 of 4 types of treatments: complete tumor resection, FN sacrifice with or without FN reconstruction, tumor resection with FN preservation and primary non-surgical treatments. Pathologic specimens in patients with nerve resection patients (n = 26) were reviewed to identify FN invasion by the tumor.
Patients with PGC and facial weakness had poor clinical outcomes (44.0%, 3Y progression-free survival), and 86.7% of tumors were high-grade. In these subjects, regional or distant metastasis was an independent prognostic factor for survival. Recovery from facial weakness was suboptimal in patients with FN graft. In cases with nerve resection, 26.9% had intra-neural tumor invasion, 42.3% had perineural invasion, and 30.8% had no neural invasion in the FN.
Facial weakness did not always indicate tumor invasion of the FN in PGC. Thus, the decision regarding FN resection can reasonably be further based on intraoperative findings. In cases with incomplete facial weakness and safe separation of the FN from the tumor, FN preservation offers the best functional outcomes, without compromising oncological outcomes.
在腮腺癌（PGC）中，尚不清楚面神经（FN）的肿瘤侵犯是否总会导致面部无力，需要进行神经切除。本研究的目的是评估患有 PGC 和术前面部无力患者的肿瘤学和功能结局，并分析 FN 的局部肿瘤侵犯。
回顾性分析了 45 例患有 PGC 和术前面部无力的患者的临床结局。患者接受了 4 种治疗之一：肿瘤完全切除、伴或不伴 FN 重建的 FN 牺牲、保留 FN 的肿瘤切除和原发性非手术治疗。对行神经切除患者（n=26）的病理标本进行了回顾性分析，以确定肿瘤对 FN 的侵犯。
患有 PGC 和面部无力的患者临床结局较差（44.0%，3 年无进展生存率），且 86.7%的肿瘤为高级别。在这些患者中，区域或远处转移是生存的独立预后因素。FN 移植的患者面部无力恢复不理想。在神经切除的病例中，26.9%的 FN 内有肿瘤侵犯，42.3%的 FN 有神经周围侵犯，30.8%的 FN 无神经侵犯。
在 PGC 中，面部无力并不总是表明 FN 受到肿瘤侵犯。因此，FN 切除的决定可以根据术中发现进一步合理做出。在不完全性面部无力且 FN 与肿瘤安全分离的情况下，保留 FN 可提供最佳的功能结局，而不会影响肿瘤学结局。
