Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
Histopathology. 2022 Nov;81(5):670-679. doi: 10.1111/his.14772. Epub 2022 Sep 5.
Secretory carcinoma (SC) is a rare form of salivary carcinoma that was first described in 2010 and is characterized by ETV6::NTRK3 fusion in most cases. In this large retrospective study, we aimed to identify adverse clinicopathologic factors and propose a prognostically relevant grading scheme for SC.
A detailed clinicopathologic review was conducted on 90 SCs from the major and minor salivary glands.
The median age at presentation was 50 years (range: 7-93). Sixty-nine (77%) tumours originated from major salivary glands, whereas the remaining 21 involved minor salivary glands.Six cases (7%) had cervical nodal metastasis. Only lymphovascular invasion (LVI) was associated with a risk of nodal metastasis (P < 0.05). The 5-year disease-specific survival and disease-free survival (DFS) were 98% and 87%, respectively. On univariate survival analysis, adverse prognostic factors associated with decreased DFS included minor salivary gland origin, atypical mitosis, high mitotic index, high-grade transformation (HGT), necrosis, nuclear pleomorphism, infiltrative tumour border, fibrosis at the invasive front, LVI, positive margin, and advanced pT stage (P < 0.05). When adjusted for pT stage and margin status, mitotic index, LVI, nuclear pleomorphism, and HGT remained as independent prognostic factors.
We therefore propose a two-tiered grading system for SC. The low-grade SC is defined as those with <5 mitoses /10 high-power fields and no tumour necrosis, and high-grade SC as those with ≥5 mitoses /10 high-power fields and/or necrosis. This proposed grading system can be useful to risk stratify patients with SC for appropriate clinical management.
本研究旨在识别不良临床病理因素，并提出一种用于预测涎腺癌（SC）的分级方案。
对 90 例来自大、小涎腺的 SC 进行详细的临床病理回顾。
中位发病年龄为 50 岁（范围：7-93 岁）。69 例（77%）肿瘤起源于大涎腺，其余 21 例累及小涎腺。6 例（7%）发生颈部淋巴结转移。仅淋巴血管侵犯（LVI）与发生淋巴结转移的风险相关（P<0.05）。5 年疾病特异性生存率和无病生存率（DFS）分别为 98%和 87%。单因素生存分析显示，DFS 降低的不良预后因素包括：小涎腺起源、非典型有丝分裂、高有丝分裂指数、高级别转化（HGT）、坏死、核多形性、浸润性肿瘤边界、侵袭前沿纤维化、LVI、阳性切缘和晚期 pT 分期（P<0.05）。当调整 pT 分期和切缘状态时，有丝分裂指数、LVI、核多形性和 HGT 仍然是独立的预后因素。
因此，我们提出了一种用于 SC 的两级别分级系统。低级别 SC 定义为那些有<5 个有丝分裂/10 个高倍视野且无肿瘤坏死的肿瘤，高级别 SC 定义为那些有≥5 个有丝分裂/10 个高倍视野和/或坏死的肿瘤。该分级系统可用于对 SC 患者进行风险分层，以进行适当的临床管理。
