Piwowarczyk Krzysztof, Bartkowiak Ewelina, Kosikowski Paweł, Chou Jadzia Tin-Tsen, Wierzbicka Małgorzata
Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
Department of Clinical Pathology, Poznan University of Medical Sciences, Poznan, Poland.
Front Oncol. 2021 Jan 8;10:600707. doi: 10.3389/fonc.2020.600707. eCollection 2020.
Pleomorphic adenomas (PAs) with divergent clinical behavior, differing from the vast majority of PAs, were distinguished. "Fast" PAs are characterized by an unexpectedly short medical history and relatively rapid growth. The reference group consisted of "slow" PAs with very stable biology and long-term progression. We divide the PA group as a whole into three subsets: "fast," "normal," and "slow" tumors. Our goal is a multifactorial analysis of the "fast" and "slow" PA subgroups.
Consecutive surgeries in a tertiary referral center, the Department of Otolaryngology and Laryngological Surgery, Poznan University of Medical Sciences, Poland, were carried out between 2002 and 2011. Out of 1,154 parotid tumors, 636 (55.1%) were PAs. The data were collected prospectively in collaboration with the Polish National Registry of Benign Salivary Gland Tumors. The main outcome measure was the recurrence rate in "fast" and "slow" PA subgroups. All surgical qualifications and surgeries were performed by two experienced surgeons.
Slow PAs, compared to fast PAs, presented in older patients (53.25 ± 15.29 versus 47.92 ± 13.44 years). Multifactor logistic regression analysis with recurrence (yes/no) as the outcome variable, fast/slow as the predictor variable and age, gender, margin, FN status as covariates showed that fast PAs were significantly predicting recurrence vs. slow PAs (p = 0.035). Fast PAs were increasing the risk of PAs 10-fold vs. slow PAs, exp β = 10.20, CI [1.66; 197.87]. The variables impacting relapse were recent accelerated growth of the tumor OR = 3.35 (SE = 0.56), p = 0.030, positive margins OR = 7.18 (SE = 0.57), p < 0.001, incomplete or bare capsule OR = 9.91 (SE = 0.53), p = 0.001 and location III OR = 3.12 (SE = 0.53), p = 0.033. In the multivariate model only positive margin was selected as the best predictor of relapse, OR = 5.01 (SE = 0.60), p = 0.007.
The simple clinical aspect of slow or fast PA progression is of great practical importance and can constitute a surrogate of the final histopathological information that is derived from the surgical specimen. The slow or fast nature of the PA to some extent indicates prognostic features such as recurrence risk. This finding requires correlation with histological and molecular features in further stages of research.
鉴别出具有不同临床行为、与绝大多数多形性腺瘤（PA）不同的多形性腺瘤。“快速进展型”PA的特点是病史意外地短且生长相对迅速。参照组由生物学行为非常稳定且进展缓慢的“缓慢进展型”PA组成。我们将整个PA组分为三个亚组：“快速进展型”、“普通型”和“缓慢进展型”肿瘤。我们的目标是对“快速进展型”和“缓慢进展型”PA亚组进行多因素分析。
2002年至2011年期间，在波兰波兹南医科大学耳鼻喉科及喉外科这一三级转诊中心进行了连续手术。在1154例腮腺肿瘤中，636例（55.1%）为PA。数据是与波兰国家涎腺良性肿瘤登记处合作前瞻性收集的。主要观察指标是“快速进展型”和“缓慢进展型”PA亚组的复发率。所有手术资格评估和手术均由两名经验丰富的外科医生进行。
与快速进展型PA相比，缓慢进展型PA多见于老年患者（53.25±15.29岁对47.92±13.44岁）。以复发（是/否）为结果变量、快速/缓慢为预测变量以及年龄、性别、切缘、FN状态为协变量的多因素逻辑回归分析显示，与缓慢进展型PA相比，快速进展型PA显著预测复发（p = 0.035）。与缓慢进展型PA相比，快速进展型PA使PA复发风险增加10倍，指数β = 10.20，可信区间[1.66；197.87]。影响复发的变量包括肿瘤近期加速生长，比值比（OR）= 3.35（标准误[SE] = 0.56），p = 0.030；切缘阳性，OR = 7.18（SE = 0.57），p < 0.001；包膜不完整或无包膜，OR = 9.91（SE = 0.53），p = 0.001；以及位于Ⅲ区，OR = 3.12（SE = 0.53），p = 0.033。在多变量模型中，仅切缘阳性被选为复发的最佳预测指标，OR = 5.01（SE = 0.60），p = 0.007。
PA进展缓慢或快速这一简单临床特征具有重要的实际意义，并且可以作为从手术标本得出的最终组织病理学信息的替代指标。PA的缓慢或快速性质在一定程度上表明了诸如复发风险等预后特征。这一发现需要在进一步研究阶段与组织学和分子特征进行关联。
