Gallo O, Franchi A, Bottai G V, Fini-Storchi I, Tesi G, Boddi V
Institute of Otolaryngology Head & Neck Surgery, University of Florence, Italy.
Cancer. 1997 Sep 1;80(5):844-51.
Distant metastases (DM) have become an increasingly common cause of death in cancer patients because of the increasing therapeutic control of locoregional disease. However, little data exist regarding the role of clinical factors in predicting the likelihood of DM in patients with carcinoma of the parotid gland.
To analyze the incidence of DM and the factors involved in developing DM, the authors retrospectively studied clinical and survival data from 124 consecutive patients with parotid gland carcinoma who were surgically treated at the Institute of Otolaryngology of the University of Florence.
DM occurred in 33 of 124 patients (26.6%). Patients with high grade carcinoma had a higher occurrence of DM than those with low grade disease (30.6% vs. 17.9%; P = 0.033). The presence or absence of tumor positive cervical lymph nodes in dissection specimens significantly influenced the occurrence of DM (68.2% vs. 23.7%) (P = 0.007), as well as the number of histologically positive cervical lymph nodes (P = 0.014). Clinical signs of local tumor extension, particularly facial nerve impairment, were found to be associated with a higher rate of DM (P = 0.008). Moreover, tumor size (P = 0.0216) and clinical stage (P = 0.010) were prognostically significant in predicting the incidence of DM. Interestingly, locoregional tumor failure (P = 0.096) did not affect the risk of DM. Multivariate Cox proportional hazards analysis showed that clinical stage and facial nerve infiltration were the most important factors in predicting the risk of DMs (P = 0.010; hazard ratio [HR]: 3.75; 95% confidence interval [CI]: 1.14-13.05 and P = 0.041; HR: 2.75; 95% CI: 1.04-7.30, respectively).
Tumor stage and local aggressiveness were found to be the major prognostic factors in predicting the risk of distant failure in patients with carcinoma of the parotid gland.
由于对局部区域疾病的治疗控制不断提高，远处转移（DM）已成为癌症患者越来越常见的死亡原因。然而，关于临床因素在预测腮腺癌患者发生DM可能性中的作用的数据很少。
为了分析DM的发生率以及发生DM的相关因素，作者回顾性研究了佛罗伦萨大学耳鼻喉科研究所连续手术治疗的124例腮腺癌患者的临床和生存数据。
124例患者中有33例发生DM（26.6%）。高级别癌患者的DM发生率高于低级别癌患者（30.6%对17.9%；P = 0.033）。解剖标本中有无肿瘤阳性颈部淋巴结对DM的发生有显著影响（68.2%对23.7%）（P = 0.007），以及组织学阳性颈部淋巴结的数量（P = 0.014）。发现局部肿瘤扩展的临床体征，特别是面神经损伤，与较高的DM发生率相关（P = 0.008）。此外，肿瘤大小（P = 0.0216）和临床分期（P = 0.010）在预测DM发生率方面具有预后意义。有趣的是，局部区域肿瘤复发（P = 0.096）并不影响DM的风险。多因素Cox比例风险分析表明，临床分期和面神经浸润是预测DM风险的最重要因素（P = 0.010；风险比[HR]：3.75；95%置信区间[CI]：1.14 - 13.05和P = 0.041；HR：2.75；95% CI：1.04 - 7.30）。
肿瘤分期和局部侵袭性是预测腮腺癌患者远处转移风险的主要预后因素。
