Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Laryngoscope. 2021 Aug;131(8):E2461-E2468. doi: 10.1002/lary.29547. Epub 2021 Apr 1.
OBJECTIVE(S): Although parotid cancer invading into the temporal bone makes up only a small fraction of all parotid cancers, it is more common and relatively understudied compared with primary cancer of the external auditory canal. The objective of this study was to determine what factors are associated with receiving parotidectomy with temporal bone resection (TBR) and the immediate postoperative outcomes.
We reviewed the National Cancer Database (2004-2015) for patients with primary parotid malignancy who received parotidectomy with or without TBR. Patient demographic, clinical, and perioperative variables were collected and then compared. Multivariate logistic regression was performed to determine factors associated with receiving TBR.
We identified 134 patients who received parotidectomy with TBR and 16,595 who received parotidectomy only. Reported in terms of odds ratios (95% confidence interval), our multivariate model showed having surgery at an academic facility (1.91 [1.34-2.71], P < .001), clinical stage III or IV (7.48 [1.65-33.96] and 31.37 [7.61-129.32], P = .009 and P < .001, respectively), histologic grade II to IV (4.36 [1.51-12.57], 4.31 [1.53-12.15], and 6.74 [2.26-20.13], P = .006, .006, and .001, respectively), and adenoid cystic histology (3.23 [2.02-5.17], P < .001) were significantly and independently associated with receiving TBR. There was no significant difference in 30-day readmission, or 30-day or 90-day mortality, but the rate of positive surgical margins was significantly higher in those who underwent TBR.
Demographic variables are not significant factors for receiving TBR. Tumor characteristics, such as clinical stage and histologic type, and receiving surgical treatment at an academic facility were more strongly associated with receiving TBR.
3 Laryngoscope, 131:E2461-E2468, 2021.
尽管腮腺癌侵犯颞骨仅占所有腮腺癌的一小部分，但与外耳道原发性癌症相比，其发病率更高，研究也相对较少。本研究的目的是确定哪些因素与接受腮腺切除术联合颞骨切除术（TBR）及术后即刻结果有关。
我们检索了国家癌症数据库（2004-2015 年）中接受腮腺恶性肿瘤切除术的患者，包括接受单纯腮腺切除术和腮腺切除术联合 TBR 的患者。收集患者的人口统计学、临床和围手术期变量，然后进行比较。采用多变量逻辑回归确定与接受 TBR 相关的因素。
我们共纳入 134 例接受 TBR 的患者和 16595 例接受单纯腮腺切除术的患者。多变量模型显示，在学术医疗机构接受手术（优势比[95%置信区间]：1.91[1.34-2.71]，P<0.001）、临床分期 III 或 IV 期（7.48[1.65-33.96]和 31.37[7.61-129.32]，P=0.009 和 P<0.001）、组织学分级 II 至 IV 级（4.36[1.51-12.57]、4.31[1.53-12.15]和 6.74[2.26-20.13]，P=0.006、0.006 和 0.001）和腺样囊性组织学（3.23[2.02-5.17]，P<0.001）与接受 TBR 显著相关。两组患者在 30 天内再入院率、30 天或 90 天死亡率方面无显著差异，但 TBR 组的切缘阳性率显著较高。
人口统计学变量不是接受 TBR 的重要因素。肿瘤特征，如临床分期和组织学类型，以及在学术医疗机构接受手术治疗与接受 TBR 更密切相关。
3 Laryngoscope, 131:E2461-E2468, 2021.
