Mori Kosei, Yamasaki Kazuki, Morimoto Yuki, Kinoshita Takashi, Asai Shunichi, Arai Tomoyuki, Iinuma Tomohisa, Yonekura Syuji, Hanazawa Toyoyuki
Department of Otorhinolaryngology/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan.
Department of Head and Neck Surgery, Chiba Cancer Center, Chiba 260-8717, Japan.
Life (Basel). 2022 Oct 24;12(11):1685. doi: 10.3390/life12111685.
Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor, and its prognosis is determined by the histological progression beyond the adenoma capsule. However, a preoperative evaluation of the histological progression remains challenging, and there is no consensus regarding treatment strategies for CXPA. Herein, we aimed to predict the histological progression preoperatively and develop an appropriate treatment strategy for CXPA. We retrospectively reviewed 22 patients with parotid gland CXPA recorded at our hospital. The clinicopathological characteristics were assessed, and survival analysis was performed. T3≤ or N+ were common in widely invasive CXPA (WICXPA) (p < 0.05). A tumor diameter > 40 mm and the N+ status were associated with poor prognosis considering overall survival (OS) and locoregional recurrence rate (LRC) (p < 0.05). Patients with facial nerve paralysis exhibited better OS and LRC than those without facial nerve paralysis. More than 90% of patients with WICXPA experienced distant metastases. Meanwhile, there were no cases of recurrence or death due to intracapsular and minimally invasive CXPA. A preoperative advanced T stage or N+ status was suspected as WICXPA. Tumors > 40 mm in size and N+ status necessitate high-intensity local treatment. Facial nerve invasion can be controlled by nerve resection. Postoperative systemic therapy could control distant metastases.
多形性腺瘤恶变（CXPA）是一种罕见的恶性涎腺肿瘤，其预后取决于腺瘤包膜外的组织学进展。然而，术前对组织学进展的评估仍然具有挑战性，并且关于CXPA的治疗策略尚无共识。在此，我们旨在术前预测组织学进展并为CXPA制定合适的治疗策略。我们回顾性分析了我院记录的22例腮腺CXPA患者。评估了其临床病理特征并进行了生存分析。在广泛浸润性CXPA（WICXPA）中，T3≤或N+较为常见（p<0.05）。考虑到总生存期（OS）和局部区域复发率（LRC），肿瘤直径>40mm和N+状态与预后不良相关（p<0.05）。面神经麻痹患者的OS和LRC优于无面神经麻痹的患者。超过90%的WICXPA患者发生远处转移。同时，囊内型和微浸润性CXPA无复发或死亡病例。术前怀疑为晚期T分期或N+状态的为WICXPA。直径>40mm的肿瘤和N+状态需要高强度局部治疗。面神经侵犯可通过神经切除控制。术后全身治疗可控制远处转移。
