Voora Rohith S, Panuganti Bharat, Califano Joseph, Coffey Charles, Guo Theresa
University of California, San Diego School of Medicine, La Jolla, California, USA.
Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego School of Medicine, La Jolla, California, USA.
Otolaryngol Head Neck Surg. 2023 May;168(5):1067-1078. doi: 10.1002/ohn.167. Epub 2023 Jan 19.
The role and extent of neck dissection in primary parotid cancer are controversial. Herein, we characterize patterns of lymph node metastasis in parotid cancer.
Retrospective analysis.
National Cancer Database.
Patients with the 6 most common histologic subtypes of parotid cancer were selected. Primary outcomes were the distribution of positive lymph nodes by level and overall survival assessed by Cox analysis. Secondary outcomes included predictors of extended lymph node involvement (≥3 lymph nodes or Level IV/V involvement), via logistic regression.
Six thousand nine hundred seventy-seven patients with acinic cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma (CExPA), mucoepidermoid carcinoma, and salivary duct carcinoma (SDC) were included. Among cN0 patients, 8.2% of low-grade tumor patients had occult nodal metastasis versus 30.9% in high-grade tumor patients. Elective neck dissection was not associated with an overall survival benefit (adjusted hazard ratio: 1.10; 0.94-1.30, p = .238). Among cN+ tumors, CExPA (odds ratio [OR]: 1.88, 1.05-3.39, p = .034) and high-grade pathology (OR: 3.03, 1.87-4.93, p < .001) were predictive of having ≥3 pathologic nodes. CExPA (OR: 2.13, 1.22-3.72, p = .008), adenocarcinoma (OR: 1.60, 1.11-2.31, p = .013), SDC (OR: 1.92, 1.17-3.14, p < .01), and high-grade pathology (OR: 3.61, 2.19-5.97, p < .001) were predictive of Level IV/V neck involvement.
In parotid malignancy, nodal metastasis distribution is dependent on histology and grade. High-grade tumors and certain histologies (SDC and adenocarcinoma) had a higher incidence of occult nodes. Comprehensive neck dissection should also be considered for node-positive high-grade tumors, SDC, and adenocarcinoma.
颈清扫术在原发性腮腺癌中的作用和范围存在争议。在此，我们描述腮腺癌淋巴结转移的模式。
回顾性分析。
国家癌症数据库。
选择患有6种最常见组织学亚型腮腺癌的患者。主要结局是按水平划分的阳性淋巴结分布情况以及通过Cox分析评估的总生存期。次要结局包括通过逻辑回归分析预测广泛淋巴结受累（≥3个淋巴结或IV/V区受累）的因素。
纳入了6977例患有腺泡细胞癌、腺癌、腺样囊性癌、多形性腺瘤癌变（CExPA）、黏液表皮样癌和涎腺导管癌（SDC）的患者。在cN0患者中，低级别肿瘤患者隐匿性淋巴结转移率为8.2%，而高级别肿瘤患者为30.9%。选择性颈清扫术与总生存期获益无关（调整后的风险比：1.10；0.94 - 1.30，p = 0.238）。在cN+肿瘤中，CExPA（优势比[OR]：1.88，1.05 - 3.39，p = 0.034）和高级别病理（OR：3.03，1.87 - 4.93，p < 0.001）可预测有≥3个病理阳性淋巴结。CExPA（OR：2.13，1.22 - 3.72，p = 0.008）、腺癌（OR：1.60，1.11 - 2.31，p = 0.013）、SDC（OR：1.92，1.17 - 3.14，p < 0.01）和高级别病理（OR：3.61，2.19 - 5.97，p < 0.001）可预测IV/V区颈部受累。
在腮腺恶性肿瘤中，淋巴结转移分布取决于组织学类型和分级。高级别肿瘤以及某些组织学类型（SDC和腺癌）隐匿性淋巴结转移的发生率较高。对于淋巴结阳性的高级别肿瘤、SDC和腺癌，也应考虑行根治性颈清扫术。
