Carcinomas arising in the submandibular gland: High propensity for systemic failure
Carcinomas arising in the submandibular gland: High propensity for systemic failure
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DOI：
10.1002/jso.20993
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发表时间：
2008-05-01
影响因子：
2.5
通讯作者：
Kim, Sang Yoon
中科院分区：
文献类型：
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作者：
Roh, Jong-Lyel;Choi, Seung-Ho;Kim, Sang Yoon
背景资料：颌下腺癌是罕见的，只有少数小系列报道患者的生存和预后。方法：我们研究了62例手术治疗的颌下腺癌的治疗结果。所有患者均接受手术切除伴/不伴颈淋巴结清扫术，41例接受术后放疗，治疗高级别、侵袭性、边缘阳性或区域转移性肿瘤。Kaplan-Meier法计算局部控制率和生存率，单因素和多因素分析计算预后因素。结果：62例下颌下腺癌中，腺样囊性癌19例，粘液表皮样癌11例，涎腺导管癌10例，多形性腺瘤癌8例。5年局部控制率、无远处转移生存率、无病生存率和总生存率分别为69.7%、65.8%、52.8%和56.8%。多因素分析中，T分期和组织学分级是无病生存的预后因素（P < 0.01），T分期和切缘是局部控制的预后因素（P < 0.02）。在初始分期（n = 2）或随访（n = 19）中发现21例（33.9%）远处转移。结论：尽管有效的局部治疗，约三分之一的患者与颌下腺癌可能会失败全身，导致生存率低。这些患者可能需要新的，更有效的治疗方法。
Background: Cancers of the submandibular gland are uncommon and only a few small series have reported patient survival and prognosis.Methods: We examined the treatment outcomes of 62 patients with surgically treated submandibular gland carcinomas. All patients underwent surgical excision with/without neck dissection, and 41 received postoperative radiotherapy for high-grade, invasive, positive margin, or regionally metastatic tumors. The locoregional control and survival rates were calculated by the Kaplan-Meier method and prognostic factors were calculated from uni- and multivariate analyses.Results: Of the 62 submandibular gland carcinomas, 19 were adenoid cystic, 11 were mucoepidermoid, and 10 were salivary duct carcinomas, and 8 were carcinomas in pleomorphic adenoma. Actuarial 5-year locoregional control, distant metastasis-free survival, disease-free and overall survival rates were 69.7%, 65.8%, 52.8%, and 56.8%, respectively. In multivariate analysis, T category and histological grading were prognostic for disease-free survival (P < 0.01), and T category and resection margins were prognostic for locoregional control (P < 0.02). Distant metastases were found in 21 patients (33.9%) at initial staging (n = 2) or follow-up (n = 19).Conclusions: Despite effective locoregional treatment, approximately one-third of patients with submandibular gland carcinomas may fail systemically, resulting in poor survival. New, more effective therapies may be required for these patients.