Primary salivary gland-type lung cancer - Spectrum of clinical presentation, histopathologic and prognostic factors
Primary salivary gland-type lung cancer - Spectrum of clinical presentation, histopathologic and prognostic factors
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DOI：
10.1002/cncr.23048
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发表时间：
2007-11-15
期刊：
影响因子：
6.2
通讯作者：
Cassivi, Stephen D.
中科院分区：
文献类型：
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作者：
Molina, Julian R.;Aubry, Marie Christine;Cassivi, Stephen D.
背景。原发性唾液腺型肺癌是罕见的肿瘤，包括腺样囊性癌（ACC）和粘液表皮样癌（MEC）。 ACC 和 MEC 患者作为一个整体的临床病理特征、就诊症状和长期结果最近尚未确定。方法。在这项研究中，作者分析了 1972 年至 2002 年在梅奥诊所（明尼苏达州罗彻斯特）诊断为原发性唾液型肺癌的 62 名患者的临床结果数据。 结果。 MEC 患者诊断时的中位年龄为 40 岁（范围为 6-78 岁）；对于 ACC 患者，诊断时的中位年龄为 54 岁（范围为 21-76 岁）。 ACC 在女性和女孩中更常见。两种肿瘤的主要症状都是咳嗽（70%），其次是呼吸困难（51.7%）、喘息（38.3%）、阻塞性肺炎（30%）、咯血（28.3%）和发热（16.7%）。所有患者的组织均可供检查。 ACC肿瘤中，筛状肿瘤29例（74.4%），管状肿瘤7例（17.9%），实性型3例（7.7%）。大多数 MEC 肿瘤 (65%) 为中级（2 级），30% 为低级（1 级）。大多数唾液型肺癌出现在气管、隆突或主干支气管中（70.7%）。与 MEC 肿瘤 (44.4%) 相比，ACC 肿瘤更常观察到该位置 (82.5%)。 20% 的患者观察到淋巴结受累，并且在 ACC 患者中更为常见 (30.8%)。 30.4% 的患者观察到远处转移（ACC 组有 15 名患者 [40.5%]，而 MEC 组只有 2 名患者 [10.5%]；P = .03）。对于接受完全手术切除的患者，3年、5年和10年生存率分别为82%、70%和63%。手术 MEC 患者的 3 年生存率为 94%，5 年和 10 年生存率为 87%。对于手术 ACC 患者，3 年、5 年和 10 年生存率分别为 73%、57% 和 45%。未接受手术的 ACC 患者的 3 年生存率为 74%，5 年生存率为 53%，10 年生存率为 31%。手术和非手术患者的生存率差异具有统计学意义（P < .01）。结论。 MEC 和 ACC 患者通常具有良好的长期预后，但并不总是患有惰性疾病。如果手术不能完全切除，则可能会出现局部复发。 ACC 比 MEC 转移的可能性更高。总体而言，MEC 患者比 ACC 患者生存得更好。
BACKGROUND. Primary salivary-type lung cancers are rare tumors that include adenoid cystic carcinoma (ACC) and mucoepidermoid carcinoma (MEC). The clinicopathologic profiles, symptoms on presentation, and long-term outcomes of patients with ACC and MEC as an overall group have not been defined recently.METHODS. in this study, the authors analyzed clinical outcome data from 62 patients who presented with a diagnosis of primary salivary-type lung cancer at the Mayo Clinic (Rochester, Minn) from 1972 to 2002.RESULTS. The median age at diagnosis for patients with MEC was 40 years (range, 6-78 years); and, for patients ACC, the median age at diagnosis was 54 years (range, 21-76 years). ACC was observed more frequently among women and girls. The main presenting symptom for both tumors was cough (70%), followed by dyspnea (51.7%), wheezing (38.3%), obstructive pneumonia (30%), hemoptysis (28.3%), and fever (16.7%). Tissues were available for review from all patients. Among the ACC tumors, 29 (74.4%) were cribriform, 7 (17.9%) were tubular, and 3 (7.7%) were the solid type. Most MEC tumors (65%) were intermediate grade (grade 2), and 30% were low grade (grade 1). Most salivary-type lung cancers presented in the trachea, in the carina, or in a main stem bronchus (70.7%). This location was observed more often (82.5%) for ACC tumors compared with MEC tumors (44.4%). Involvement of the lymph nodes was observed in 20% of patients and was more common among the patients with ACC (30.8%). Distant metastases were observed in 30.4% of the patients (15 patients in the ACC group [40.5%] compared with only 2 patients in the MEC group [10.5%]; P = .03). For patients who underwent complete surgical resection, the 3-, 5-, and 10-year survival rates were 82%, 70%, and 63%, respectively. The survival rates for surgical MEC patients were 94% at 3 years and 87% at both 5 years and 10 years. For surgical ACC patients, the survival rates were 73%, 57%, and 45% at 3, 5, and 10 years, respectively. The survival rate for patients with ACC who did not undergo surgery was 74% at 3 years, 53% at 5 years, and 31% at 10 years. The difference in survival between surgical and nonsurgical patients was statistically significant (P < .01).CONCLUSIONS. Patients with MEC and ACC frequently have a good long-term prognosis but do not always have indolent diseases. Local recurrence is likely if complete surgical resection is not achieved. ACC has a higher likelihood than MEC to metastasize. Overall, patients with MEC survive better than patients with ACC.