唾液腺癌不同分级对死亡率的比较影响：一种新型统一分期系统。

Comparative impact of grade on mortality across salivary cancers: A novel, unifying staging system.

作者信息

Ho Allen S, Luu Michael, Balzer Bonnie L, Aro Katri, Jang Julie K, Mita Alain C, Scher Kevin S, Mallen-St Clair Jon, Vasquez Missael, Bastien Amanda J, Epstein Joel B, Lin De-Chen, Chen Michelle M, Zumsteg Zachary S

机构信息

Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

出版信息

Head Neck. 2023 Aug;45(8):2028-2039. doi: 10.1002/hed.27429. Epub 2023 Jun 22.

DOI:10.1002/hed.27429

PMID:37345665

Abstract

BACKGROUND

The comparative impact of histologic variants and grade has not been well described.

METHODS

Salivary cancer histologies were profiled using hospital and population-based cancer registries. Multivariable models were employed to assess relationships between histology, grade, and survival.

RESULTS

On univariate analysis, histologic variants exhibited a wide spectrum of mortality risk (5-year overall survival (OS): 86% (acinic cell carcinoma), 78% (mucoepidermoid carcinoma), 72% (adenoid cystic carcinoma), 64% (carcinoma ex-pleomorphic adenoma), 52% (adenocarcinoma NOS), and 47% (salivary duct carcinoma) (p < 0.001). However, on multivariable analysis these differences largely vanished. Worsening grade corresponded with deteriorating survival (5-year OS: 89% [low-grade], 81% [intermediate-grade], 45% [high-grade]; p < 0.001), which was upheld on multivariable analysis and propensity score matching. Recursive partitioning analysis generated TNM + G schema (c-index 0.75) superior to the existing system (c-index 0.73).

CONCLUSION

Grade represents a primary determinant of salivary cancer prognosis. Integrating grade into stage strengthens current staging systems.

摘要

背景

组织学变异和分级的比较性影响尚未得到充分描述。

方法

利用医院和基于人群的癌症登记系统对唾液腺癌组织学进行分析。采用多变量模型评估组织学、分级与生存率之间的关系。

结果

单变量分析显示，组织学变异呈现出广泛的死亡风险谱（5年总生存率（OS）：86%（腺泡细胞癌）、78%（黏液表皮样癌）、72%（腺样囊性癌）、64%（多形性腺瘤癌变）、52%（未特指腺癌）和47%（涎腺导管癌）（p < 0.001）。然而，多变量分析时这些差异基本消失。分级恶化与生存率下降相关（5年OS：89%[低级别]、81%[中级]、45%[高级]；p < 0.001），多变量分析和倾向评分匹配时此结果依然成立。递归划分分析生成的TNM + G模式（c指数0.75）优于现有系统（c指数0.73）。