Department of Radiation Oncology, University Hospital of Erlangen, Friedrich -Alexander-University Erlangen-Nürnberg (FAU), Universitätsstraße 27, 91054, Erlangen, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Erlangen, Friedrich-AlexanderUniversity Erlangen-Nürnberg (FAU), Erlangen, Germany.
Eur Arch Otorhinolaryngol. 2022 May;279(5):2553-2563. doi: 10.1007/s00405-021-07024-9. Epub 2021 Aug 26.
Salivary Gland cancer (SGC) is a rare and heterogenous group of tumors. Standard therapeutic options achieve high local but poor distant control rates, especially in high-grade SGC. The aim of this monocentric study was to evaluate patterns of recurrence and its treatment options (local ablative vs. systemic) in a homogenously treated patient population with high-grade SGC after surgery and radio(chemo)therapy.
Monocentric, retrospective study of patients with newly diagnosed high-grade salivary gland cancer. We retrospectively reviewed clinical reports from 69 patients with high-grade salivary gland cancer in a single-center audit. Survival rates were calculated using the Kaplan-Meier method and prognostic variables were analyzed (univariate analysis: log-rank test; multivariate analysis: Cox regression analysis).
The median time of follow-up was 31 months. After 5 years, the cumulative overall survival was 65.2%, cumulative incidence of local recurrence was 7.2%, whereas the cumulative incidence of distant metastases was 43.5% after 5 years. 30 of 69 patients developed distant metastases during the time of follow-up, especially patients with adenoid cystic carcinoma, salivary duct carcinoma, adenocarcinoma NOS and acinic cell carcinoma with high-grade transformation. The most common type of therapy therefore was chemotherapy (50%). 85.7% of patients with local ablative therapy of distant metastases show disease progression during follow-up afterwards.
With surgery and radio-chemotherapy, a high rate of loco-regional control is reached, but over 40% of patients develop distant metastases in the further follow-up which usually present a diffuse pattern involving in a diffuse metastases. Therefore, in the future, intensified interdisciplinary combination therapies even in the first-line treatment in certain subtypes of high-grade SGC should be investigated.
唾液腺癌（SGC）是一组罕见且异质性的肿瘤。标准治疗方案可实现高局部控制率，但远处控制率较差，尤其是在高级别 SGC 中。本单中心研究的目的是评估手术后和放化疗后高级别 SGC 患者在同质化治疗人群中的复发模式及其治疗选择（局部消融与全身治疗）。
对新诊断为高级别唾液腺癌的患者进行单中心回顾性研究。我们对单一中心的 69 例高级别唾液腺癌患者的临床报告进行了回顾性审查。使用 Kaplan-Meier 方法计算生存率，并分析预后变量（单因素分析：对数秩检验；多因素分析：Cox 回归分析）。
中位随访时间为 31 个月。5 年后，累积总生存率为 65.2%，累积局部复发率为 7.2%，而 5 年后远处转移累积发生率为 43.5%。69 例患者中有 30 例在随访期间发生远处转移，特别是腺样囊性癌、唾液导管癌、非特异性腺癌和高级别转化的腺泡细胞癌患者。因此，最常见的治疗类型是化疗（50%）。85.7%接受局部消融治疗远处转移的患者在随访期间疾病仍有进展。
通过手术和放化疗可达到较高的局部控制率，但超过 40%的患者在后续随访中发生远处转移，通常表现为弥漫性模式，累及广泛转移。因此，未来应研究强化的多学科联合治疗，甚至在某些高级别 SGC 亚型的一线治疗中也应研究。
