Clinical Outcomes and Prognostic Factors for Salivary Duct Carcinoma: A Multi-Institutional Analysis of 141 Patients.
Clinical Outcomes and Prognostic Factors for Salivary Duct Carcinoma: A Multi-Institutional Analysis of 141 Patients.
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DOI：
10.1245/s10434-015-5082-2
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发表时间：
2016-06
影响因子：
3.7
通讯作者：
Nagao T
中科院分区：
文献类型：
--
作者：
Otsuka K;Imanishi Y;Tada Y;Kawakita D;Kano S;Tsukahara K;Shimizu A;Ozawa H;Okami K;Sakai A;Sato Y;Ueki Y;Sato Y;Hanazawa T;Chazono H;Ogawa K;Nagao T
涎腺恶性肿瘤中，涎腺导管癌(SDC)被认为是预后最差的。然而，由于其发病率较低，基于大量患者的可靠的生存估计和预后因素仍有待阐明，从而使SDC的最佳治疗方案无法标准化。我们通过收集141例接受根治性手术作为初始治疗的无远处转移的SDC患者的临床资料，进行了多机构的回顾性分析，以阐明总体生存期(OS)和无病生存期(DFS)及其预后因素。3年OS和DFS率分别为70.5%和38.2%。多因素分析显示，年龄≥65岁(P<0.001)和N1、N_2(P=0.047和P<0.001)是OS的独立预后因素，而小涎腺和舌下腺的原发部位(P<0.001)和N_2(P<0.001)是影响OS预后的独立因素。最常见的治疗失败是远处转移(55例，39.0%)。对于早期腮腺SDC，无论是早期T期患者的腮腺全切除，还是非面神经麻痹患者的神经切除，均无生存益处。高级N阶段独立影响操作系统和DFS。保留面神经的腮腺部分切除术是治疗T期早期腮腺SDC无面神经麻痹的一种微创的标准手术方式。有效的系统治疗是提高SDC患者DFS的关键。
Among salivary gland malignancies, the prognosis of salivary duct carcinoma (SDC) is assumed to be the poorest. However, because of its low incidence, reliable survival estimates and prognostic factors based on a large number of patients remain to be elucidated, thereby making it impossible to standardize the optimal treatment for SDC. We performed this multi-institutional, retrospective analysis by collecting the clinical information of 141 patients with SDC without distant metastasis who underwent curative surgery as the initial treatment to elucidate overall survival (OS) and disease-free survival (DFS) along with their prognostic factors. The 3-year OS and DFS rates were 70.5 and 38.2 %, respectively. Multivariate analysis revealed that age ≥65 years (p < 0.001) and N1 and N2 (p = 0.047 and <0.001, respectively) were independent prognostic factors for OS, whereas the primary site of the minor salivary and sublingual gland (p < 0.001) and N2 (p < 0.001) were those for DFS. The most common treatment failure was distant metastasis (55 patients, 39.0 %). For early parotid SDC, neither total parotidectomy in the patients with early T stage nor nerve resection in the patients without facial nerve palsy showed survival benefits. Advanced N stage independently affects both OS and DFS. Partial parotidectomy with facial nerve preservation could be a less invasive standard surgical procedure for parotid gland SDC in the early T stage without facial nerve palsy. Effective systemic therapy is imperative to improve DFS of SDC.