涎腺癌患者颈部的外科治疗。
Surgical treatment of the neck in patients with salivary gland carcinoma.
机构信息
Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.
Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
出版信息
Head Neck. 2021 Jun;43(6):1898-1911. doi: 10.1002/hed.26667. Epub 2021 Mar 18.
BACKGROUND
Elective neck dissection (END) in patients with salivary gland carcinoma is controversial and there are no universally accepted guidelines.
METHODS
Patients were identified from the Danish Head and Neck Cancer Group. Between 2006 and 2015, 259 patients with primary salivary gland carcinoma were treated with END. Variables potentially associated with regional metastases were analyzed using logistic regression. Neck recurrence-free survival was calculated using the Kaplan-Meier method.
RESULTS
Occult metastases were found in 36 of the patients treated with END (14%) and were particularly frequent among patients with T3/T4 tumors and high-grade histology tumors. In multivariate analyses, high-grade histology and vascular invasion were associated with occult metastases.
CONCLUSION
We recommend END of levels II and III for patients with high-grade or unknown histological grade tumors, and for T3/T4 tumors. Levels I, II, and III should be included in END in patients with submandibular, sublingual, or minor salivary gland carcinomas.
背景
对于唾液腺癌患者，选择性颈部清扫术（END）存在争议，目前尚无普遍接受的指南。
方法
患者来自丹麦头颈部癌症组。2006 年至 2015 年间，对 259 例原发性唾液腺癌患者进行了 END 治疗。使用逻辑回归分析与局部转移相关的潜在变量。采用 Kaplan-Meier 法计算颈部无复发生存率。
结果
接受 END 治疗的患者中有 36 例（14%）发现隐匿性转移，其中 T3/T4 肿瘤和高级别组织学肿瘤患者中隐匿性转移更为常见。多变量分析显示，高级别组织学和血管侵犯与隐匿性转移相关。
结论
我们建议对高级别或组织学分级未知的肿瘤患者以及 T3/T4 肿瘤患者进行 II 级和 III 级颈部清扫术。对于下颌下腺、舌下腺或小唾液腺癌患者，应包括 I、II 和 III 级的颈部清扫术。
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