大唾液腺黏液表皮样癌的组织细胞分级对预后和生存的影响：一项临床病理及流式细胞术研究
Histocytologic grading of mucoepidermoid carcinoma of major salivary glands in prognosis and survival: a clinicopathologic and flow cytometric investigation.
作者信息
Hicks M J, el-Naggar A K, Flaitz C M, Luna M A, Batsakis J G
机构信息
Department of Anatomic Pathology, University of Texas M.D. Anderson Cancer Center, Houston, USA.
出版信息
Head Neck. 1995 Mar-Apr;17(2):89-95. doi: 10.1002/hed.2880170203.
BACKGROUND
Controversy exists regarding the role of a 3-tiered grading system for mucoepidermoid carcinoma (MEC) of salivary glands in prognosis and survival. This retrospective investigation evaluated a 3-tiered grading system modified from Healey by Batsakis and Luna and compared various clinical, pathologic, and flow cytometric parameters and overall survival among MECs of differing grades.
METHODS
Forty-eight patients with 7 low-grade (LG), 23 intermediate-grade (IG), and 18 high-grade (HG) MECs of parotid (n = 43) and submandibular (n = 5) glands were studied. Data were analyzed using categorical statistics (Wilcoxon, Kruskal-Wallis and Chi-squared tests where appropriate).
RESULTS
Mean ages were 42 years for patients with LG tumors; 47 years, IG; and 59 years, HG (p = 0.02). Gender ratio (p < 0.001) changed from female predominance in LG (6 F:1 M) and IG (2.1 F:1 M) to male predominance in HG (3.5 M:1 F). Mean tumor stage was 1.4 LG, 2.4 IG, and 3.6 HG (p < 0.005). Tumor size increased from 2.1 cm for LG to 3.8 cm for HG (p = 0.01). Margins were involved by tumor in 0% LG, 44% IG, and 61% HG (p < 0.001). Lymph node involvement was 0% LG, 22% IG, and 72% HG (p < 0.001). DNA aneuploidy (DNA index < 0.9 or > 1.1) was present in 0% LG, 13% IG, and 28% HG (p = 0.05). Proliferative fraction (S + G2M) was 5% LG, 7% IG, and 13% HG (p = 0.008). Radiotherapy was administered in 14% LG, 35% IG, and 61% HG (p = 0.03). Recurrences (local and/or metastatic) occurred in 0% LG, 39% IG, and 61% HG (p = 0.009). Survival was decreased significantly (p < 0.0001) with increasing tumor grade (100% LG, 70% IG, and 22% HG).
CONCLUSION
Histologic grading of mucoepidermoid carcinomas of major salivary glands, using the modified Healey 3-tiered system, correlates well with clinical, pathologic, and flow cytometric factors which influence the prognosis and overall survival in affected individuals.
背景
关于涎腺黏液表皮样癌（MEC）的三级分级系统在预后和生存中的作用存在争议。这项回顾性研究评估了由巴茨卡斯和卢娜对希利分级系统进行修改后的三级分级系统，并比较了不同分级的MEC的各种临床、病理和流式细胞术参数以及总生存率。
方法
对48例患有腮腺（n = 43）和下颌下腺（n = 5）的低级别（LG）7例、中级（IG）23例和高级别（HG）18例MEC的患者进行了研究。使用分类统计方法（适当情况下采用威尔科克森、克鲁斯卡尔 - 沃利斯和卡方检验）分析数据。
结果
LG肿瘤患者的平均年龄为42岁；IG为47岁；HG为59岁（p = 0.02）。性别比例（p < 0.001）从LG（6名女性：1名男性）和IG（2.1名女性：1名男性）中的女性占优势变为HG（3.5名男性：1名女性）中的男性占优势。平均肿瘤分期LG为1.4、IG为2.4、HG为3.6（p < 0.005）。肿瘤大小从LG的2.1 cm增加到HG的3.8 cm（p = 0.01）。LG肿瘤边缘受累为0%，IG为44%，HG为61%（p < 0.001）。淋巴结受累LG为0%，IG为22%，HG为72%（p < 0.001）。DNA非整倍体（DNA指数< 0.9或> 1.1）在LG中为0%，IG中为13%，HG中为28%（p = 0.05）。增殖分数（S + G2M）LG为5%，IG为7%，HG为13%（p = 0.008）。接受放疗的比例LG为14%，IG为35%，HG为61%（p = （此处原文似乎有误，推测为p = 0.03））。复发（局部和/或转移）LG为0%，IG为39%，HG为61%（p = 0.009）。随着肿瘤分级增加，生存率显著降低（p < 0.0001）（LG为100%，IG为70%，HG为22%）。
结论
使用改良的希利三级系统对大涎腺黏液表皮样癌进行组织学分级，与影响受影响个体预后和总生存的临床、病理和流式细胞术因素密切相关。
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