Bang Jooin, Lee Oh-Hyeong, Kim Geun-Jeon, Sun Dong-Il, Kim Sang-Yeon
Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Medicina (Kaunas). 2024 Nov 25;60(12):1942. doi: 10.3390/medicina60121942.
The role of occult nodal metastases in patients with parotid gland cancers remains unclear; such metastases are histologically diverse and exhibit unpredictable clinical courses. Here, we evaluated the prognostic utilities of such metastases, including metastases in the intraparenchymal lymph nodes (PARs). We retrospectively reviewed the medical charts of patients who underwent surgery to treat clinically N0 primary parotid gland cancers from 2000 to 2022. The primary outcome variables were 5-year overall survival (OS) and 5-year disease-free survival (DFS). We explored the effects of occult nodal metastases, including metastases in the PARs, especially in terms of the pathological T (pT) classification. Among 74 patients, 48 (64.8%) were pT1/2 cases, and 26 (35.2%) were pT3/4 cases. Both perineural and lymphatic invasion were negatively associated with the 5-year DFS (hazard ratio [HR] = 3.533, 95% confidence interval [CI] = 1.325-9.421, = 0.012; HR = 4.028, 95% CI = 1.497-10.839, = 0.006, respectively). During pathological review, PAR metastases were observed in 12 patients (16.2%), and other occult metastases were present in 8 patients (10.8%). PAR metastases reduced the 5-year DFS in pT1/2 cases (87.2% vs. 22.2%, = 0.001) but not in pT3/4 cases. PAR metastases significantly reduced the 5-year DFS in patients with clinically N0 primary parotid gland cancer. On subgroup analysis according to pT classification, this effect was significant among patients with early pT1/2 status but not patients with advanced pT3/4 status.
隐匿性淋巴结转移在腮腺癌患者中的作用仍不明确；此类转移在组织学上具有多样性，且临床病程不可预测。在此，我们评估了此类转移的预后效用，包括实质内淋巴结（PARs）转移。我们回顾性分析了2000年至2022年接受手术治疗临床N0期原发性腮腺癌患者的病历。主要结局变量为5年总生存率（OS）和5年无病生存率（DFS）。我们探讨了隐匿性淋巴结转移的影响，包括PARs转移，尤其是在病理T（pT）分类方面。74例患者中，48例（64.8%）为pT1/2病例，26例（35.2%）为pT3/4病例。神经周围浸润和淋巴浸润均与5年DFS呈负相关（风险比[HR]=3.533，95%置信区间[CI]=1.325 - 9.421，P = 0.012；HR = 4.028，95%CI = 1.497 - 10.839，P = 0.006）。在病理检查中，12例患者（16.2%）观察到PAR转移，8例患者（10.8%）存在其他隐匿性转移。PAR转移降低了pT1/2病例的5年DFS（87.2%对22.2%，P = 0.001），但在pT3/4病例中未降低。PAR转移显著降低了临床N0期原发性腮腺癌患者的5年DFS。根据pT分类进行亚组分析，这种影响在早期pT1/2状态的患者中显著，但在晚期pT3/4状态的患者中不显著。
