Graves Jeffrey P, Bukowski Emily E K, O'Byrne Thomas Jamie, Yin Linda X, Tasche Kendall K, Van Abel Kathryn M, Price Daniel L, Moore Eric J
Mayo Clinic Alix School of Medicine, Rochester, MN, USA; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
Am J Otolaryngol. 2024 Nov-Dec;45(6):104446. doi: 10.1016/j.amjoto.2024.104446. Epub 2024 Jul 31.
Acinic cell carcinoma (ACC) most frequently arises in the parotid gland. Treatment consists of surgical resection and sometimes adjuvant therapy. ACC is most often a low-grade malignancy with good prognosis. Higher-grade tumors are often treated aggressively with total parotidectomy, neck dissection, and adjuvant therapy; however, the effect of parotid gland resection extent on oncologic outcomes has not been studied. Herein, we examine predictors of oncologic outcomes, including the effect of extent of resection.
Patients with diagnosis of parotid ACC treated at our institution were included in this retrospective study. Patient factors were examined, and patients were grouped by extent of resection and tumor grade.
58 patients, including 32 low-grade, 7 intermediate-grade, and 14 high-grade were included. Patients with low-grade tumors were more likely to undergo lesser extent of parotidectomy and less likely to undergo neck dissection. Two patients with low grade tumors developed recurrence, one local and one regional. Recurrence rate did not differ with resection extent in low-grade tumors. High tumor grade was found to be associated with disease progression. There was no association with adjuvant treatment and outcomes. Across all tumor grades advanced AJCC stage was found to be associated with disease progression.
In ACC patients with low-grade tumors and lower disease stage who undergo lesser extent of surgical resection oncologic outcomes were favorable. Patients with high-grade tumors carry a high risk of recurrence, despite aggressive treatment. AJCC stage and histopathologic grade may predict outcomes and guide treatment.
腺泡细胞癌（ACC）最常发生于腮腺。治疗方法包括手术切除，有时还需辅助治疗。ACC通常为低级别恶性肿瘤，预后良好。高级别肿瘤常采用腮腺全切术、颈部清扫术及辅助治疗等积极治疗方法；然而，腮腺切除范围对肿瘤学结局的影响尚未得到研究。在此，我们研究肿瘤学结局的预测因素，包括切除范围的影响。
本回顾性研究纳入了在我院接受治疗的腮腺ACC患者。对患者因素进行了检查，并根据切除范围和肿瘤分级对患者进行分组。
共纳入58例患者，其中低级别32例、中级别7例、高级别14例。低级别肿瘤患者更有可能接受范围较小的腮腺切除术，且较少接受颈部清扫术。2例低级别肿瘤患者出现复发，1例为局部复发，1例为区域复发。低级别肿瘤的复发率与切除范围无关。发现高肿瘤分级与疾病进展相关。辅助治疗与结局无关。在所有肿瘤分级中，AJCC晚期与疾病进展相关。
在接受手术切除范围较小的低级别肿瘤且疾病分期较低的ACC患者中，肿瘤学结局良好。高级别肿瘤患者尽管接受了积极治疗，但复发风险仍很高。AJCC分期和组织病理学分级可预测结局并指导治疗。
