Stodulski Dominik, Mikaszewski Bogusław, Majewska Hanna, Kuczkowski Jerzy
Department of Otolaryngology, Medical University of Gdańsk, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland.
Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland.
Eur Arch Otorhinolaryngol. 2019 Jul;276(7):2031-2038. doi: 10.1007/s00405-019-05454-0. Epub 2019 May 6.
The aim of the study was to assess the treatment results of the parotid gland salivary duct carcinoma (SDC).
A retrospective clinicopathological analysis of 40 patients treated for parotid SDC in 1996-2015 was performed. The impact of following factors on 5-year disease-free survival (DFS) and overall survival (OS) was studied: age, sex, preoperative 7th nerve palsy, skin infiltration, pT, pN, surgical margin, type of parotidectomy and neck dissection, histology (SDC de novo vs. SDC ex pleomorphic adenoma, SDCexPA), intra/periparotid lymph nodes metastases, perineural invasion (PNI), extraparenchymal extension (EPE), and overexpression HER2.
The average age of the patients was 62 years (ranged from 39 to 81). Males predominated (57.5%). Patients with the clinical stage IV predominated (82.5%). In 1/3 of patients preoperative, 7th nerve palsy occurred. All patients were treated surgically, and all but one had supplementary radiotherapy. In 28 patients (70%), total radical parotidectomy was performed. A neck dissection was performed in all patients. In 19 cases (47.5%), SDCexPA was diagnosed. Negative microscopic surgical margin was obtained in 60% of patients. The follow-up for the whole analyzed group ranged from 2 to 22 years, average was 11.6 years. In 23 patients (57.5%), the disease recurred. Local recurrence was observed in 10 (25%) and distant metastases in 15 (37.5%) cases. 20 patients (50%) died of cancer. 5-year DSF and OS were 42.5% and 41%, respectively. Univariate analysis proved that the significant influence on the survival had 7th nerve palsy (p = 0.024 and p = 0.017, respectively), higher pT-stage (p < 0.001), radical parotidectomy (p = 0.024 and p = 0.022), radical treatment of the neck (p = 0.001 and p = 0.002), EPE (p = 0.040 and p = 0.028), and histology SDCexPA and PNI (p = 0.036 and 0.048). Multivariate analysis showed that independent prognostic factors were the 7th nerve palsy and the histology SDCexPA, which worsened 5-year DFS, respectively, 3.61 and 3.94 times (p = 0.033 and p = 0.026). On the other hand, on 5-year OS, only 7th nerve palsy had an influence (3.86 times worse prognosis, p = 0.033).
SDC is a clinically aggressive cancer with high risk of local recurrence and distant metastases, however, with a chance of curing of around 40%. In the majority of patients, a radical surgical treatment is necessary due to the high clinical stage of disease. Worse prognosis have patients with preoperative 7th nerve palsy and in whom SDC develops in pleomorphic adenoma.
本研究旨在评估腮腺涎腺导管癌（SDC）的治疗效果。
对1996年至2015年期间接受腮腺SDC治疗的40例患者进行回顾性临床病理分析。研究了以下因素对5年无病生存率（DFS）和总生存率（OS）的影响：年龄、性别、术前第VII神经麻痹、皮肤浸润、pT、pN、手术切缘、腮腺切除术和颈部清扫术的类型、组织学（新发SDC与多形性腺瘤恶变SDC，SDCexPA）、腮腺内/周围淋巴结转移、神经周围侵犯（PNI）、腺实质外扩展（EPE）以及HER2过表达。
患者的平均年龄为62岁（范围为39至81岁）。男性占主导（57.5%）。临床分期为IV期的患者占主导（82.5%）。1/3的患者术前出现第VII神经麻痹。所有患者均接受手术治疗，除1例患者外均接受了辅助放疗。28例患者（70%）接受了根治性全腮腺切除术。所有患者均进行了颈部清扫术。19例患者（47.5%）诊断为SDCexPA。60%的患者获得了显微镜下手术切缘阴性。整个分析组的随访时间为2至22年，平均为11.6年。23例患者（57.5%）疾病复发。10例（25%）观察到局部复发，15例（37.5%）观察到远处转移。20例患者（50%）死于癌症。5年DFS和OS分别为42.5%和41%。单因素分析证明，对生存率有显著影响的因素有第VII神经麻痹（p分别为0.024和0.017）、较高的pT分期（p<0.001）、根治性腮腺切除术（p分别为0.024和0.022）、颈部根治性治疗（p分别为0.001和0.002）、EPE（p分别为0.040和0.028）以及组织学SDCexPA和PNI（p分别为0.036和0.048）。多因素分析表明，独立的预后因素是第VII神经麻痹和组织学SDCexPA，它们分别使5年DFS恶化3.61倍和3.9倍（p分别为0.033和0.026）。另一方面，对5年OS而言，只有第VII神经麻痹有影响（预后差3.86倍，p=0.033）。
SDC是一种临床侵袭性癌症，局部复发和远处转移风险高，然而，有大约40%的治愈机会。由于疾病的临床分期高大多数患者需要进行根治性手术治疗。术前有第VII神经麻痹以及SDC发生于多形性腺瘤的患者预后较差。
