Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma.
Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma.
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DOI：
10.1186/s40463-018-0273-z
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发表时间：
2018-04-25
期刊：
影响因子：
--
通讯作者：
Yom SS
中科院分区：
文献类型：
--
作者：
Xu MJ;Wu TJ;van Zante A;El-Sayed IH;Algazi AP;Ryan WR;Ha PK;Yom SS
腺样囊性癌(ACC)局部区域复发(LRR)和远处转移(DM)的治疗受到有限数据的指导。我们调查了确诊和治疗的复发性ACC患者的死亡风险。对至2016年收治的慢性阻塞性肺疾病患者进行了回顾性分析，发现有36例患者患有下呼吸道感染或糖尿病。高危疾病定义为颅底受累(LRR)或国际肺转移登记III/IV组或肺外转移部位(DM)。使用Kaplan-Meier方法、对数等级检验和Cox比例风险分析进行时间-事件分析。20例LRR和16例DM患者的中位复发时间分别为51个月和50个月。复发后的中位随访期为37.5个月(IQR为16.5~56.5)。复发后3年总生存率(OS)分别为78.5%、73.3%和85.1%(p = 0.62)。高危复发与3年OS较差有关(高危68.8%，低危92.3%，χ2 = 10.4，p = 0.001)。在LRR患者中，90%的患者将手术作为治疗的一部分。综合治疗、年龄和组织病理学特征(大小、边缘、实质组织学、淋巴血管或神经周围侵犯)与PFS或OS无关。高危LRR是唯一与OS相关的变量(χ2 = 5.9，p = 0.0 1)。在DM患者中，6名患者最初接受了观察，10名患者接受了手术、RT或系统治疗。前期治疗与PFS或OS的改善无关。高危DM是唯一与OS相关的变量(χ2 = 4.7，p = 0.0 3)。高危LRR和DM与3年OS降低相关。对于高风险的ACC复发，需要更有效的治疗。
Management of locoregional recurrence (LRR) and distant metastasis (DM) in adenoid cystic carcinoma (ACC) is guided by limited data. We investigated mortality risks in patients diagnosed and treated for recurrent ACC. A retrospective review of ACC patients treated from 1989 to 2016 identified 36 patients with LRR or DM. High-risk disease was defined as skull base involvement (for LRR) or International Registry of Lung Metastases Group III/IV or extrapulmonary site of metastasis (for DM). Kaplan-Meier method, log-rank tests, and Cox proportional hazards were used for time-to-event analysis. Among 20 LRR and 16 DM patients, the median times to recurrence were 51 and 50 months, respectively. The median follow-up post-recurrence was 37.5 months (interquartile range (IQR)16.5–56.5). Post-recurrence 3-year overall survival (OS) was 78.5%, 73.3% for LRR and 85.1% for DM (p = 0.62). High-risk recurrences were associated with worse 3-year OS (68.8% for high-risk and 92.3% for low-risk, χ2 = 10.4, p = 0.001). Among LRR patients, 90% had surgery as part of their treatment. Multimodality therapy, age, and histopathologic features (size, margins, solid histology, lymphovascular or perineural invasion) were not associated with PFS or OS. High-risk LRR was the only variable associated with OS (χ2 = 5.9, p = 0.01). Among DM patients, six were initially managed with observation and ten received surgery, RT, or systemic therapy. Upfront therapy was not associated with improved PFS or OS. High-risk DM was the only variable associated with OS (χ2 = 4.7, p = 0.03). High-risk LRR and DM were associated with decreased 3-year OS. More effective therapies are needed for high-risk ACC recurrences.
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影响因子：
3.4
作者：
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通讯作者：
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影响因子：
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作者：
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作者：
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DOI：
10.1016/j.oooo.2012.11.018
发表时间：
2013-03-01
影响因子：
2.9
作者：
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通讯作者：
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