Leverstein H, van der Wal J E, Tiwari R M, Tobi H, van der Waal I, Mehta D M, Snow G B
Department of Otolaryngology, Head and Neck Surgery, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Br J Surg. 1998 Sep;85(9):1267-72. doi: 10.1046/j.1365-2168.1998.00820.x.
Optimal management of malignant epithelial parotid tumours requires knowledge of the available therapeutic modalities and the different biological characteristics. The aim of the study was to review the characteristics of patients at presentation, histological classification, disease-free and overall survival rates, and the results of the applied treatment policy regarding the facial nerve and neck.
Between 1974 and 1995 a total of 65 patients was treated with curative intent for a previously untreated malignant epithelial parotid gland tumour. All patients underwent some type of parotidectomy, 20 of whom had an en bloc radical neck dissection. In selected cases the facial nerve or its branches were peeled off the tumour thus violating the objective of tumour-free margins and relying heavily on the efficacy of postoperative radiotherapy. In total 51 patients received postoperative radiotherapy. None of the patients was lost to follow-up.
There were 12 locoregional failures (18 per cent). In only one of these 12 patients was salvage therapy successful; the remaining 11 patients died from the tumour. All but one of the eight patients with distant metastasis only died from the tumour. The estimated 5- and 10-year disease-free rates were 68 and 59 per cent respectively. The corresponding survival rates were 75 per cent and 67 per cent. A significant relationship could be observed between tumour stage and survival. The presence of lymph node metastases proved to be the strongest single prognostic factor.
In selected cases a conservative approach towards the facial nerve is justified.
恶性腮腺上皮肿瘤的最佳治疗需要了解现有的治疗方式以及不同的生物学特性。本研究的目的是回顾患者的临床表现特征、组织学分类、无病生存率和总生存率，以及关于面神经和颈部的应用治疗策略的结果。
1974年至1995年间，共有65例患者接受了针对先前未经治疗的恶性腮腺上皮肿瘤的根治性治疗。所有患者均接受了某种类型的腮腺切除术，其中20例患者进行了整块根治性颈淋巴结清扫术。在某些病例中，面神经或其分支从肿瘤上剥离，从而违反了无瘤切缘的目标，并严重依赖术后放疗的疗效。共有51例患者接受了术后放疗。所有患者均未失访。
有12例局部区域复发（18%）。在这12例患者中，只有1例挽救治疗成功；其余11例患者死于肿瘤。8例仅有远处转移的患者中，除1例之外均死于肿瘤。估计的5年和10年无病生存率分别为68%和59%。相应的生存率分别为75%和67%。肿瘤分期与生存之间存在显著关系。淋巴结转移的存在被证明是最强的单一预后因素。
在某些病例中，对面神经采取保守方法是合理的。
