Prognostic Implication of Histopathologic Indicators in Salivary Duct Carcinoma
Prognostic Implication of Histopathologic Indicators in Salivary Duct Carcinoma
复制标题
唾液管癌组织病理学指标的预后意义
DOI：
10.1097/pas.0000000000001413
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Nagao Toshitaka et al.
中科院分区：
文献类型：
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作者：
Nakaguro Masato;Sato Yukiko;Tada Yuichiro;Kawakita Daisuke;Nagao Toshitaka et al.
涎腺导管癌是一种罕见的侵袭性恶性肿瘤，组织学上类似于高级别乳腺导管癌。由于这种疾病的罕见性，证实组织学特征与患者生存之间关系的数据有限。我们对151例SDC病例进行了全面的组织学回顾，并分析了各种组织学参数与临床结果之间的关系，目的是建立一个预测SDC患者预后的组织学风险分层模型。多因素分析显示，突出的核多形性（总生存期[OS]: P= 0.013；无进展生存期[PFS]: P= 0.019）、≥30个有丝分裂/10个HPF （PFS: P= 0.013）、高肿瘤出芽（OS: P= 0.011; PFS: P< 0.001）和高低分化簇（OS: P< 0.001; PFS: P< 0.001）是独立的预后因素。在多变量分析中，血管侵犯患者与较短的PFS有轻微的显著相关（P= 0.064）。我们提出了一个3层的组织学风险分层模型，该模型基于4个预后相关参数（突出的核多形性、≥30个有丝分裂/10个HPF、血管侵犯和高低分化簇）中阳性因素的总数。低危（0 ~ 1分）（23%）、中危（2 ~ 3分）（54%）、高危（4分）（23%）肿瘤患者的OS和PFS依次进行性恶化（风险比分别为2.13、2.28、4.99、4.50，P趋势< 0.001）。我们的组织学风险分层模型可以有效地预测患者的生存，并可能有助于指导与SDC患者管理相关的临床决策。
Salivary duct carcinoma (SDC) is a rare, aggressive malignancy that histologically resembles high-grade mammary duct carcinoma. Because of the rarity of this entity, data verifying the association between histologic features and patient survival are limited. We conducted a comprehensive histologic review of 151 SDC cases and performed an analysis of the association between various histomorphologic parameters and the clinical outcome with the aim of developing a histologic risk stratification model that predicts the prognosis of SDC patients. A multivariate analysis revealed that prominent nuclear pleomorphism (overall survival [OS]: P= 0.013; progression-free survival [PFS]: P= 0.019),≥ 30 mitoses/10 HPF (PFS: P= 0.013), high tumor budding (OS: P= 0.011; PFS: P< 0.001), and high poorly differentiated clusters (OS: P< 0.001; PFS: P< 0.001) were independent prognostic factors. Patients with vascular invasion demonstrated a marginally significant association with shorter PFS (P= 0.064) in a multivariate analysis. We proposed a 3-tier histologic risk stratification model based on the total number of positive factors among 4 prognostically relevant parameters (prominent nuclear pleomorphism,≥ 30 mitoses/10 HPF, vascular invasion, and high poorly differentiated clusters). The OS and PFS of patients with low-risk (0 to 1 point)(23% of cases), intermediate-risk (2 to 3 points)(54% of cases), and high-risk (4 points)(23% of cases) tumors progressively deteriorated in this order (hazard ratio, 2.13 and 2.28, and 4.99 and 4.50, respectively; P trend< 0.001). Our histologic risk stratification model could effectively predict patient survival and may be a useful aid to guide clinical decision-making in relation to the management of patients with SDC.