Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Cancer. 2020 May 15;126(10):2153-2162. doi: 10.1002/cncr.32792. Epub 2020 Feb 25.
Distant metastases (DMs) are the primary cause of treatment failure in patients with salivary gland carcinoma. There is no consensus on the standard treatment.
Patients with DMs were identified from an institutional database of 884 patients with salivary gland cancer who underwent resection of the primary tumor between 1985 and 2015. Survival outcomes for patients with DMs were determined with the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify factors associated with DM.
Of the 884 patients identified, 137 (15%) developed DMs during follow-up. Most of the primary tumors (n = 77 [56%]) were located in a major salivary gland. At clinical presentation, 53% of the tumors were classified as T3 or T4, and 32% had clinical node metastases. The median time to DM was 20.3 months. The factors associated with shorter distant recurrence-free survival were male sex, high-risk tumor histology, and advanced pathological T and N classifications. Patients with bone metastases had a lower survival rate than patients with lung metastases. The total number of DMs in a patient was inversely associated with survival. Patients who underwent surgical resection of DMs had a significantly higher 5-year rate of metastatic disease-specific survival than patients who underwent observation or nonsurgical treatment (44%, 29%, and 19%, respectively; P = .003).
In patients with DMs of salivary gland carcinoma, survival is negatively associated with high-grade histology, bone DMs, and the total number of DMs. Metastasectomy can help to lengthen disease-free survival.
远处转移（DMs）是导致唾液腺癌患者治疗失败的主要原因。目前对于其标准治疗方法尚无共识。
从 1985 年至 2015 年间接受原发肿瘤切除术的 884 例唾液腺癌患者的机构数据库中确定患有 DMs 的患者。采用 Kaplan-Meier 法确定患有 DMs 的患者的生存结局。采用单因素和多因素分析来确定与 DM 相关的因素。
在确定的 884 例患者中，有 137 例（15%）在随访期间发生了 DMs。大多数原发肿瘤（n=77[56%]）位于大唾液腺中。在临床表现中，53%的肿瘤被分类为 T3 或 T4，32%有临床淋巴结转移。DM 出现的中位时间为 20.3 个月。与远处无复发生存时间较短相关的因素包括男性、高危肿瘤组织学和较高的病理 T 和 N 分级。有骨转移的患者比有肺转移的患者生存率低。患者的总转移灶数与生存呈反比。接受 DMs 手术切除的患者的 5 年转移性疾病特异性生存率明显高于接受观察或非手术治疗的患者（分别为 44%、29%和 19%；P=0.003）。
在患有 DMs 的唾液腺癌患者中，生存与高级别组织学、骨 DMs 和总转移灶数呈负相关。转移灶切除术有助于延长无病生存期。
