腮腺多形性腺瘤恶变的临床病理特征及预后因素：126例中国人群病例的临床病理分析

Clinicopathologic Features and Prognostic Factors of Widely Invasive Carcinoma Ex Pleomorphic Adenoma of Parotid Gland: A Clinicopathologic Analysis of 126 Cases in a Chinese Population.

作者信息

Hu Yuhua, Xia Liang, Zhang Chunye, Xia Ronghui, Tian Zhen, Li Jiang

机构信息

Attending Physician, Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine National Clinical Research Center for Oral Disease and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.

Resident Physician, Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine National Clinical Research Center for Oral Disease and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.

出版信息

J Oral Maxillofac Surg. 2020 Dec;78(12):2247-2257. doi: 10.1016/j.joms.2020.06.013. Epub 2020 Jun 13.

DOI:10.1016/j.joms.2020.06.013

PMID:32649893

Abstract

PURPOSE

Salivary intracapsular carcinoma ex pleomorphic adenoma (ICCXPA) and minimally invasive CXPA (MICXPA) generally have favorable outcomes. In contrast, widely invasive CXPA (WICXPA) frequently results in disease-related death. The aims of the present study were to analyze the differences in the clinicopathologic features between parotid gland ICCXPA or MICXPA and WICXPA and the prognostic factors for WICXPA.

MATERIALS AND METHODS

We performed a retrospective cohort study. The clinicopathologic parameters of patients with primary CXPA of the parotid gland from our 2001 to 2012 cohort were reviewed. The predictor variable was a set of heterogeneous factors grouped into demographic, clinical, and pathologic features. The primary outcome variable was the tumor diagnosis, grouped into 3 categories: ICCXPA, MICXPA, and WICXPA. For statistical analysis, ICCXPA and MICXPA were combined into 1 group, with WICXPA analyzed separately. The differences in the clinicopathologic parameters between the 2 groups (ICCXPA plus MICXPA vs WICXPA) were evaluated using the χ test or t test. The secondary outcome variable was disease-specific survival (DSS) of those with WICXPA. The survival data for WICXPA were statistically analyzed using the Kaplan-Meier method and Cox regression.

RESULTS

A total of 241 cases of CXPA had been diagnosed, including 63 cases of ICCXPA, 52 cases of MICXPA, and 126 cases of WICXPA. The patients with WICXPA were older than were those with ICCXPA/MICXPA (59.6 vs 51.4 years; P < .001) and had a larger tumor diameter (3.9 vs 3.3 cm; P = .040). The proportion of histologic high-grade tumor (P < .001), proportion of carcinoma more than 50% (P < .001), and proportion of lymph node involvement (P < .001) was greater in those with WICXPA. Cox regression analysis indicated that age, T stage, and N stage were independent prognostic factors of DSS for those with WICXPA.

CONCLUSIONS

Older age, later T stage, a greater proportion of carcinoma, histologic high-grade findings, and lymph node involvement were associated with parotid gland WICXPA. Age, T stage, and N stage were the important independent factors for predicting the prognosis of patients with parotid gland WICXPA.

摘要

目的

腮腺囊内癌（ICCXPA）和微侵袭性多形性腺瘤癌（MICXPA）通常预后良好。相比之下，广泛侵袭性多形性腺瘤癌（WICXPA）常导致与疾病相关的死亡。本研究的目的是分析腮腺ICCXPA或MICXPA与WICXPA之间临床病理特征的差异以及WICXPA的预后因素。

材料与方法

我们进行了一项回顾性队列研究。回顾了2001年至2012年队列中腮腺原发性多形性腺瘤癌患者的临床病理参数。预测变量是一组异质性因素，分为人口统计学、临床和病理特征。主要结局变量是肿瘤诊断，分为3类：ICCXPA、MICXPA和WICXPA。为进行统计分析，将ICCXPA和MICXPA合并为1组，对WICXPA进行单独分析。使用χ检验或t检验评估两组（ICCXPA加MICXPA与WICXPA）临床病理参数的差异。次要结局变量是WICXPA患者的疾病特异性生存（DSS）。使用Kaplan-Meier法和Cox回归对WICXPA的生存数据进行统计分析。

结果

共诊断出241例多形性腺瘤癌，包括63例ICCXPA、52例MICXPA和126例WICXPA。WICXPA患者比ICCXPA/MICXPA患者年龄更大（59.6岁对51.4岁；P <.001），肿瘤直径更大（3.9 cm对3.3 cm；P = 0.040）。WICXPA患者中组织学高级别肿瘤的比例（P <.001）、癌占比超过50%的比例（P <.001）和淋巴结受累比例（P <.001）更高。Cox回归分析表明，年龄、T分期和N分期是WICXPA患者DSS的独立预后因素。