Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Eur Arch Otorhinolaryngol. 2021 Jun;278(6):2033-2040. doi: 10.1007/s00405-020-06317-9. Epub 2020 Aug 30.
Unexpected parotid cancers are often encountered due to inaccuracies in the preoperative evaluation. This study aimed to examine the clinical characteristics and oncological outcomes of these cancers and to propose the appropriate management strategy.
This is a multicenter case series study in which a total of 302 patients were diagnosed postoperatively with parotid cancers between 2003 and 2017. Of these, 85 cases without evidence of malignancy prior to surgery but identified as malignant on postoperative pathology were included.
Of 85 patients, 76 and 9 underwent superficial and total parotidectomy, respectively. A positive resection margin was present in 24.7% of the cases. Postoperative radiotherapy was administered to 43.6% of patients; 4.2% had a local recurrence, and no patients died of the disease. The 5-year overall and relapse-free survival rates were 100.0% and 95.2%, respectively. Patients who underwent piecemeal resection had significantly poorer oncologic outcomes. Age, sex, histologic grade, T stage, extracapsular extension, resection margin status, and postoperative radiotherapy did not affect recurrence and survival.
Preoperatively unexpected parotid cancers had excellent local control and overall survival despite positive or close resection margin, with or without postoperative radiotherapy. Therefore, patients with unexpected parotid malignancies may benefit from less aggressive postoperative management option.
由于术前评估不准确，经常会遇到意外的腮腺癌。本研究旨在探讨这些癌症的临床特征和肿瘤学结果，并提出适当的治疗策略。
这是一项多中心病例系列研究，共纳入 302 例 2003 年至 2017 年间术后诊断为腮腺癌的患者。其中 85 例术前无恶性证据，但术后病理检查为恶性。
76 例和 9 例行腮腺浅叶和全叶切除术。24.7%的病例切缘阳性。43.6%的患者接受了术后放疗；4.2%的患者局部复发，无患者死于该病。5 年总生存率和无复发生存率分别为 100.0%和 95.2%。行部分切除术的患者肿瘤学结果明显较差。年龄、性别、组织学分级、T 分期、包膜外侵犯、切缘状态和术后放疗均不影响复发和生存。
尽管存在阳性或接近切缘，以及是否进行术后放疗，术前意外的腮腺癌仍具有良好的局部控制和总体生存率。因此，意外的腮腺恶性肿瘤患者可能受益于侵袭性较小的术后治疗选择。
