Jones A S, Hamilton J W, Rowley H, Husband D, Helliwell T R
Department of Otolaryngology, University of Liverpool, UK.
Clin Otolaryngol Allied Sci. 1997 Oct;22(5):434-43. doi: 10.1046/j.1365-2273.1997.00041.x.
Adenoid cystic carcinoma has a long natural history but frequently proves fatal. The present study describes 108 patients with an adenoid cystic carcinoma of the head and neck seen over a 30-year period. Analysis of the data utilized both univariate and multivariate methods. Forty per cent of patients had tumours arising from the oral cavity and half of these were in the hard palate; 29% occurred in the major salivary glands; 41% of tumours were locally advanced at presentation and 11% had lymph node metastases at this time. The histological pattern was solid in 25%, cribriform in 40% and tubular in 20%. In addition, 15% of patients had a polymorphous low-grade adenocarcinoma and these were analysed separately. Primary site recurrence was more common in the presence of locally advanced tumours at presentation (T3-4) (P = 0.0093). Only six patients had surgery with adjuvant radiotherapy. Six patients had no curative treatment, 21 had primary radiotherapy, 39 had local excision and 42 radical excision. The actuarial primary site recurrence rate was 100% at 30 years. The neck node recurrence rate was 23% at 15 years. Tumour specific survival was 40% at 20 years. Solid histology had a worse prognosis than other histological types (P = 0.0429) but those patients with polymorphous low-grade adenocarcinomas fared very well. Patients with tumours of the hard palate fared better than those patients with tumours at other sites (P = 0.0301). Early disease at the primary site (T1-2) was a good prognostic sign (P = 0.0013). Patients with neck node metastases at presentation tended to do badly (P = 0.009).
腺样囊性癌自然病程较长，但往往会导致死亡。本研究描述了30年间诊治的108例头颈部腺样囊性癌患者。数据分析采用单变量和多变量方法。40%的患者肿瘤起源于口腔，其中一半位于硬腭；29%发生于大唾液腺；41%的肿瘤初诊时为局部晚期，此时11%已有淋巴结转移。组织学类型中，实性型占25%，筛状型占40%，管状型占20%。此外，15%的患者为多形性低度腺癌，对其进行单独分析。初诊时存在局部晚期肿瘤（T3 - 4）时，原发部位复发更为常见（P = 0.0093）。仅6例患者接受了手术加辅助放疗。6例患者未接受根治性治疗，21例接受了原发灶放疗，39例接受了局部切除，42例接受了根治性切除。30年时原发部位的精算复发率为100%。15年时颈部淋巴结复发率为23%。20年时肿瘤特异性生存率为40%。实性组织学类型的预后比其他组织学类型差（P = 0.0429），但多形性低度腺癌患者预后良好。硬腭肿瘤患者的预后优于其他部位肿瘤患者（P = 0.0301）。原发部位早期病变（T1 - 2）是良好的预后指标（P = 0.0013）。初诊时伴有颈部淋巴结转移的患者预后往往较差（P = 0.009）。
