Ketterer Manuel Christoph, Konrad Dahlem Kilian Kenjiro, Häussler Sophia Marie, Jakob Till Fabian, Pfeiffer Jens, Becker Christoph
Resident, Department of Otorhinolaryngology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Resident, Department of Otorhinolaryngology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
J Oral Maxillofac Surg. 2019 Nov;77(11):2355-2361. doi: 10.1016/j.joms.2019.04.009. Epub 2019 Apr 12.
Surgical management, including the extent of surgery, for patients with parotid malignant tumors has been challenging. The aims of the present study were to identify the factors associated with survival, estimate the incidence of occult nodal and intraglandular metastases, and determine the predictive influence on overall and disease-free survival, with consideration of the surgical extent.
We implemented a retrospective cohort study and identified incident cases with parotid malignant tumors from 2003 to 2016 at a single quaternary medical care and cancer center. A medical record analysis was performed retrospectively of the patient and histopathologic data. The predictor variables were age; tumor grade; T stage; N stage; facial nerve palsy; perineural, vascular, and lymphovascular invasion; completion parotidectomy; elective neck dissection; and pN0 versus pN+. Overall and disease-free survival were evaluated as primary and secondary outcome variables. Data analysis was performed as a time-to-event analysis (Kaplan-Meier method).
A total of 102 patients with parotid carcinoma had undergone surgery from 2003 to 2016 at the University Hospital Freiburg, Germany; 69 patients had undergone completion parotidectomy (total, 36; radical, 33). A total of 13 patients had occult intraparotideal lymph node metastases after elective completion parotidectomy. All the patients who had undergone elective neck dissection and clinically had had no nodal involvement (cN0) had had no pathologic lymph node metastases found (pN0). However, the predictive factors for cervical nodal involvement were high-grade tumors, locally advanced tumors (cT3-cT4), and the presence of intraparotideal nodal metastases.
The rate of occult cervical metastases in the present study was surprisingly low (0%). However, owing to the various predictive factors, elective neck dissection should be performed for high-grade or locally advanced (stage T3-T4) parotid malignoma. Moreover, we highly recommend performing completion parotidectomy for all high-grade tumors and also for locally advanced (stage T3-T4) low-grade tumors, owing to the >12% of occult intraparotideal metastases found in the present study.
腮腺恶性肿瘤患者的手术治疗，包括手术范围，一直具有挑战性。本研究的目的是确定与生存相关的因素，估计隐匿性淋巴结转移和腺内转移的发生率，并确定手术范围对总生存和无病生存的预测影响。
我们开展了一项回顾性队列研究，在一家单一的四级医疗和癌症中心确定了2003年至2016年期间的腮腺恶性肿瘤发病病例。对患者和组织病理学数据进行了回顾性病历分析。预测变量包括年龄、肿瘤分级、T分期、N分期、面神经麻痹、神经周围、血管和淋巴管侵犯、腮腺全切除术、选择性颈清扫术以及pN0与pN+。将总生存和无病生存作为主要和次要结局变量进行评估。数据分析采用事件发生时间分析（Kaplan-Meier法）。
2003年至2016年期间，德国弗莱堡大学医院共有102例腮腺癌患者接受了手术；69例患者接受了腮腺全切除术（全腮腺切除术36例，根治性腮腺切除术33例）。选择性腮腺全切除术后，共有13例患者出现隐匿性腮腺内淋巴结转移。所有接受选择性颈清扫术且临床上无淋巴结受累（cN0）的患者均未发现病理淋巴结转移（pN0）。然而，颈部淋巴结受累的预测因素为高级别肿瘤、局部晚期肿瘤（cT3-cT4）以及腮腺内淋巴结转移的存在。
本研究中隐匿性颈部转移率出奇地低（0%）。然而，由于存在多种预测因素，对于高级别或局部晚期（T3-T4期）腮腺恶性肿瘤应进行选择性颈清扫术。此外，由于本研究中发现隐匿性腮腺内转移率>12%，我们强烈建议对所有高级别肿瘤以及局部晚期（T3-T4期）低级别肿瘤均行腮腺全切除术。
