术后放疗是非转移性涎腺淋巴上皮癌的必要治疗方法吗？

Is postoperative radiotherapy an essential treatment for nonmetastatic lymphoepithelial carcinoma of the salivary gland?

机构信息

Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Shanghai Key Laboratory of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.

Department of Radiation Oncology, Eye and ENT Hospital, Fudan University, Shanghai, China.

出版信息

Radiother Oncol. 2022 Jul;172:76-82. doi: 10.1016/j.radonc.2022.05.008. Epub 2022 May 11.

DOI:10.1016/j.radonc.2022.05.008

PMID:35568285

Abstract

BACKGROUND

Lymphoepithelial carcinoma of salivary gland (LECSG) is a rare malignant tumor. Whether postoperative radiotherapy (PORT) can improve locoregional control and which patients can benefit from PORT are unknown. This study aimed to evaluate the role of PORT and provide individualized suggestions for postoperative therapy in patients with LECSG.

PATIENTS AND METHODS

We retrospectively reviewed patients with nonmetastatic LECSG who underwent surgery with or without PORT. Recursive partitioning analysis (RPA) was performed to categorize the patients and predict progression-free survival (PFS).

RESULTS

A total of 223 patients were included, 34 (15.2%) received surgery alone, whereas the remaining 189 (84.8%) underwent PORT in the initial treatment. Although patients in the PORT group were with advanced T stage and N stage, the PORT group had an advantage over the non-PORT group on 1-year, 5-year and 10-year PFS and locoregional control (LRC). PORT was an independent prognostic factor for PFS and LRC. Furthermore, compared with T stage and N stage, the size of the primary tumor and the number of positive lymph nodes were better prognostic predictors. The RPA model was generated according to the endpoint of PFS and categorized patients into 3 prognostic groups: low-risk (maximum diameter of primary lesion (≤3 cm) and number of positive lymph nodes (≤2)), intermediate-risk (maximum diameter of primary lesion (>3 cm) and number of positive lymph nodes (≤2)), and high-risk (number of positive lymph nodes (>2)), with corresponding 5-year PFS rates of 90.0%, 75.0%, and 51.0%, respectively. Significant improvement in PFS was observed in the PORT group among intermediate-risk (P = 0.000) and high-risk patients (P = 0.000).

CONCLUSIONS

PORT was shown to be a positive prognostic factor for PFS and LRC of LECSG. PORT was an essential treatment especially for patients with >3 cm maximum diameter of primary lesion and/or >2 positive lymph nodes.

摘要

背景

涎腺淋巴上皮癌（LECSG）是一种罕见的恶性肿瘤。术后放疗（PORT）是否能提高局部区域控制率，以及哪些患者能从中获益尚不清楚。本研究旨在评估 PORT 的作用，并为 LECSG 患者的术后治疗提供个体化建议。

患者与方法

我们回顾性分析了接受手术治疗或手术联合 PORT 治疗的非转移性 LECSG 患者。采用递归分区分析（RPA）对患者进行分类，并预测无进展生存期（PFS）。

结果

共纳入 223 例患者，其中 34 例（15.2%）仅接受手术治疗，其余 189 例（84.8%）在初始治疗中接受 PORT。尽管 PORT 组患者 T 分期和 N 分期较晚，但 PORT 组患者的 1 年、5 年和 10 年 PFS 和局部区域控制（LRC）均优于非 PORT 组。PORT 是 PFS 和 LRC 的独立预后因素。此外，与 T 分期和 N 分期相比，原发肿瘤的大小和阳性淋巴结的数量是更好的预后预测指标。根据 PFS 的终点生成了 RPA 模型，并将患者分为 3 个预后组：低危组（原发肿瘤最大直径（≤3cm）和阳性淋巴结数（≤2））、中危组（原发肿瘤最大直径（>3cm）和阳性淋巴结数（≤2））和高危组（阳性淋巴结数（>2）），相应的 5 年 PFS 率分别为 90.0%、75.0%和 51.0%。高危组患者中 PORT 组的 PFS 显著改善（P=0.000），中危组患者中 PORT 组的 PFS 也显著改善（P=0.000）。