Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion-Israel Institute of Technology, 31096, Haifa, Israel.
Department of Nuclear Medicine, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion-Israel Institute of Technology, 31096, Haifa, Israel.
J Cancer Res Clin Oncol. 2019 Aug;145(8):2123-2130. doi: 10.1007/s00432-019-02953-9. Epub 2019 Jun 11.
We evaluated the impact of various tumor related parameters on survival probability in a cohort of patients with malignant salivary tumors, using the Kaplan-Meier analysis.
We measured patients up to 15 years following therapy, looking at T N M stage, grade perineural invasion and extra-parenchymal spread.
Of 101 patients diagnosed with various salivary malignant tumors in our medical center, 79 patients survived while 22 died with disease (DWD). The impact of distant metastasis (M+) was devastating (survival probability at 60 months and at 180 months dropped from 0.93 (M-) to 0.40 (M+) and from 0.67 to 0.40, respectively, p = 0.0001), the impact of perineural invasion was severe (at 180 months the probability of survival dropped from 0.75 to 0.21, p = 0.002). Higher stage tumor also decreased survival (from 0.82 to 0.53 at 180 months, p = 0.002) as did poor histological grade (from 0.85 to 0.48 at 180 months, p = 0.019). Neck metastasis (N+) impact was quite moderate (at 180 months the probability of survival dropped from 0.69 to 0.58, p = 0.044) while neither tumor size (T) nor extra-parenchymal spread significantly affected survival.
Salivary tumor location and its potential to infiltrate nerves and blood vessels and to metastasize is the most telling parameter. Systemic therapy aimed at halting distant metastatic spread is the most effective therapeutic goal. Dissection of N0 neck metastasis is not necessarily a valuable treatment.
我们通过 Kaplan-Meier 分析，评估了在一组患有恶性涎腺肿瘤的患者中，各种与肿瘤相关的参数对生存概率的影响。
我们对接受治疗后 15 年的患者进行了测量，观察了 T、N、M 分期、神经周围侵犯分级和外实质扩散情况。
在我们的医疗中心诊断出的 101 例各种恶性涎腺肿瘤患者中，79 例患者存活，22 例患者死于疾病（DWD）。远处转移（M+）的影响是毁灭性的（60 个月和 180 个月时的生存概率从 M-（0.93）降至 M+（0.40），从 0.67 降至 0.40，p=0.0001），神经周围侵犯的影响是严重的（180 个月时的生存概率从 0.75 降至 0.21，p=0.002）。较高的肿瘤分期也降低了生存率（180 个月时从 0.82 降至 0.53，p=0.002），组织学分级较差也是如此（180 个月时从 0.85 降至 0.48，p=0.019）。颈部转移（N+）的影响相当适中（180 个月时的生存概率从 0.69 降至 0.58，p=0.044），而肿瘤大小（T）或外实质扩散均未显著影响生存。
涎腺肿瘤的位置及其侵袭神经和血管并转移的潜力是最关键的参数。旨在阻止远处转移扩散的全身治疗是最有效的治疗目标。对 N0 颈部转移的解剖不一定是有价值的治疗方法。
