Predictive index for lymph node management of major salivary gland cancer
Predictive index for lymph node management of major salivary gland cancer
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大唾液腺癌淋巴结处理的预测指数
DOI：
10.1002/lary.23227
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发表时间：
2012-07-01
期刊：
影响因子：
2.6
通讯作者：
Ji, Qing-Hai
中科院分区：
文献类型：
--
作者：
Wang, Yu-Long;Li, Duan-Shu;Ji, Qing-Hai
目的/假设：寻找唾液腺癌淋巴结（LN）转移的危险因素并制定LN处理方案。研究设计：以医院为基础的回顾性研究。方法：将复旦大学附属肿瘤医院头颈外科收治的唾液腺癌患者记录录入数据库，并连续选取1998年1月至2011年1月期间接受过原发性手术的219例大唾液腺癌患者进行单因素和多因素分析，以确定LN受累的危险因素。结果：58 名 (26.5%) 患者出现 LN 受累。单变量分析与颈部淋巴结受累相关的因素包括病理类型、男性、术前病程较短、面瘫、T分期晚期以及主要神经、软组织、淋巴/血管（L/V）、神经/神经周围和囊外侵犯。多变量分析确定主要神经侵犯、组织学类型、L/V 侵犯和囊外侵犯是 LN 受累的重要因素。基于四个危险因素的预测指数评分为低（105）、中（61）、高（34）和超高（19）的LN受累患者比例分别为3.8%、27.9%、55.9%和94.7%。结论：使用本报告中描述的临床病理因素的预测指数可以有效地将患者分层为淋巴结转移的风险组。基于该风险指数的综合管理应可改善唾液腺癌患者的治疗结果。
Objectives/Hypothesis: To find the risk factors of lymph node (LN) metastasis of salivary gland cancer and draw a scheme for LN management. Study Design: Hospital-based retrospective study. Methods: The records of salivary gland cancer patients treated at the Department of Head and Neck Surgery, Cancer Hospital, Fudan University, were entered in a database, and 219 consecutive patients with carcinomas of major salivary glands primarily operated on between January 1998 and January 2011 were chosen for univariate and multivariate analysis to identify risk factors for LN involvement. Results: Fifty-eight (26.5%) patients had LN involvement. Factors associated with cervical LN involvement on univariate analysis included pathologic type, male sex, shorter duration of preoperative course, facial paralysis, advanced T stage, and major nerve, soft tissue, lymphatic/vascular (L/V), neural/perineural, and extracapsular invasion. Multivariate analysis identified major nerve invasion, histologic type, L/V invasion, and extracapsular invasion as significant factors for LN involvement. The proportion of patients with LN involvement with low (105), middle (61), high (34), and super high (19) predictive index scores based on the four risk factors were 3.8%, 27.9%, 55.9%, and 94.7%, respectively. Conclusions: A predictive index using the clinicopathologic factors described in this report can effectively stratify patients into risk groups for nodal metastasis. Comprehensive management based on this risk index should improve treatment outcomes for patients with salivary gland cancer.