Zhang Y, Zhang N, Liu X X, Zhou C X
Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Feb 18;52(1):30-34. doi: 10.19723/j.issn.1671-167X.2020.01.005.
To investigate the incidence and clinicopathologic features of cervical lymph node metastasis in salivary gland adenoid cystic carcinoma (AdCC).
Retrospective analysis was made in 798 AdCC patients who underwent tumor resection during January, 2001 to January, 2019 in Peking University School and Hospital of Stomatology, especially the clincopathologic characteristics of 82 cases with lymph node metastasis.
In the study, 82 of the 798 patients were identified with cervical lymph node metastasis, which was confirmed by histopathological examination. The palate, the region of sublingual gland and mouth floor, and the parotid were the frequently involved primary sites for AdCCs. The general incidence rate of lymph node metastasis was approximately 10%. The submandibular gland, the region of sublingual gland and mouth floor, and the mobile tongue were the most frequent sites of lymph node metastasis with the incidence rates of 20.8%, 16.1%, and 15.1%, respectively; while lymph node metastasis was uncommon in the tumors which were the origin from the palate and parotid, with incidence rates of 6.1% and 3.4%, respectively. Most AdCC cases (70.7%) showed the classic "tunnel-style" metastatic pattern of occurrence, and the level I and II regions were the most frequently involved areas. The 5-year and 10-year overall survival rates of the patients with lymph node metastasis were 77.4% and 20.6% respectively, while the 5-year and 10-year overall survival rates of the patients with no lymph node metastasis were 83.5% and 57.6%, respectively. The univariate analysis demonstrated that statistically significant differences in the overall survival for the presence of lymph node metastasis (P<0.001). In the meantime, the 5-year disease-free survival rate of the patients with lymph node metastasis also showed statistically significant differences to that of the AdCC patients with no lymph node metastasis. In addition, the primary site and histological grade were significantly associated with lymph node metastasis, and the high-grade solid growth pattern was identified as a strong predictor for the occurrence of lymph node metastasis.
Cervical lymph node metastasis has a high tendency of occurrence in submandibular gland and tongue-mouth floor complex, and the high-grade solid growth pattern could be taken as a strong predictor for the occurrence of lymph node metastasis, which correlates to poor prognosis of AdCC patients. A selective neck dissection should be considered as a management in such patients.
探讨涎腺腺样囊性癌（AdCC）颈部淋巴结转移的发生率及临床病理特征。
回顾性分析2001年1月至2019年1月在北京大学口腔医学院口腔医院接受肿瘤切除的798例AdCC患者，重点分析82例有淋巴结转移患者的临床病理特征。
本研究中，798例患者中有82例经组织病理学检查确诊为颈部淋巴结转移。腭部、舌下腺及口底区域、腮腺是AdCC常见的原发部位。淋巴结转移的总体发生率约为10%。下颌下腺、舌下腺及口底区域、活动舌是最常见的淋巴结转移部位，发生率分别为20.8%、16.1%和15.1%；而起源于腭部和腮腺的肿瘤淋巴结转移较少见，发生率分别为6.1%和3.4%。大多数AdCC病例（70.7%）表现为典型的“隧道式”转移模式，Ⅰ区和Ⅱ区是最常受累区域。有淋巴结转移患者的5年和10年总生存率分别为77.4%和20.6%，无淋巴结转移患者的5年和10年总生存率分别为83.5%和57.6%。单因素分析显示，淋巴结转移与否在总生存方面存在统计学显著差异（P<0.001）。同时，有淋巴结转移患者的5年无病生存率与无淋巴结转移的AdCC患者相比也有统计学显著差异。此外，原发部位和组织学分级与淋巴结转移显著相关，高级别实性生长模式被确定为淋巴结转移发生的有力预测指标。
下颌下腺及舌 - 口底复合体颈部淋巴结转移发生率较高，高级别实性生长模式可作为淋巴结转移发生的有力预测指标，这与AdCC患者预后不良相关。对于此类患者，应考虑选择性颈清扫术作为一种治疗手段。
