Schwipper V, Schulze-Osthoff D R
Abteilung für Gesichts- und Plastische Chirurgie, Fachklinik Hornheide, Universität Münster.
Mund Kiefer Gesichtschir. 1998 Sep;2(5):242-9. doi: 10.1007/s100060050068.
Formation of metastases was observed in 246 cases (27.8%) out of a group of 884 patients with melanoma of the head and neck region treated in the years 1967-1991. In the group of patients with metastases, regional metastases were found in the cervical lymph nodes in 136 cases (55.3%). In 74 patients (30.1%) the first metastasis was a distant metastasis, i.e., the tumor had spread by hematogenic dissemination. In 53 patients (21.5%) the first metastasis was located in the parotid gland. Evaluation of the clinical data of the patients led to interesting results regarding prognosis following the different types of surgical treatment. The 5-year survival rates were established by means of multivariant analysis using the Cox model, taking into account sex and tumor thickness: Following radical tumor removal, including neck dissection and parotidectomy, the 5-year survival rate amounted to 61.8%. If the parotid gland was not removed and only tumor and cervical lymph nodes were resected, 66.2% of the patients were still alive 5 years following surgery. The difference between these two groups was statistically not significant (P = 0.07). In those cases where only the primary tumor was removed, the 5-year survival rate was 85.8% and thus significantly better than in the two other groups (P < or = 0.0001). Two conclusions can be drawn: In metastasizing melanoma of the head and neck the parotid glands are affected in 20% of the cases and thus more frequently than expected. The retrospective analysis of groups of patients differing with regard to the prognosis of their disease cannot be used to provide information on which therapy is the best. This is particularly true for the question whether or not the parotid gland should be removed in addition to a neck dissection. It will be necessary to perform a prospective randomized study in order to find answers to these questions. Such a study could be performed within DOSAK (Deutsch-Osterreich-Schweizerischer Arbeitskreis für Tumoren im Mund-Kiefer-Gesichtsbereich = German, Austrian, Swiss Working Group on Tumors in the Maxillo-Facial Region) in cooperation with different hospitals.
在1967年至1991年期间接受治疗的884例头颈部黑色素瘤患者中，观察到246例（27.8%）发生了转移。在发生转移的患者组中，136例（55.3%）在颈部淋巴结发现区域转移。74例患者（30.1%）首次转移为远处转移，即肿瘤通过血行播散扩散。53例患者（21.5%）首次转移位于腮腺。对患者临床资料的评估得出了关于不同类型手术治疗后预后的有趣结果。采用Cox模型进行多变量分析，同时考虑性别和肿瘤厚度，确定5年生存率：在包括颈部清扫术和腮腺切除术在内的根治性肿瘤切除术后，5年生存率为61.8%。如果未切除腮腺，仅切除肿瘤和颈部淋巴结，66.2%的患者术后5年仍存活。这两组之间的差异在统计学上不显著（P = 0.07）。在仅切除原发肿瘤的病例中，5年生存率为85.8%，因此明显优于其他两组（P≤0.0001）。可以得出两个结论：在头颈部转移性黑色素瘤中，20%的病例腮腺受累，比预期更频繁。对疾病预后不同的患者组进行回顾性分析，无法提供哪种治疗最佳的信息。对于除颈部清扫术外是否应切除腮腺的问题尤其如此。有必要进行前瞻性随机研究以找到这些问题的答案。这样的研究可以在DOSAK（德语：Deutsch-Osterreich-Schweizerischer Arbeitskreis für Tumoren im Mund-Kiefer-Gesichtsbereich，即德国、奥地利、瑞士颌面区域肿瘤工作组）内与不同医院合作进行。
