原发性大唾液腺鳞状细胞癌预后因素分析  

Prognostic factors of primary major salivary gland squamous cell carcinoma

作　　者：刘雪[1] 胡涵光[1] Liu Xue;Hu Hanguang(Department of Oncology,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院肿瘤内科,浙江杭州310009

出　　处：《实用肿瘤杂志》2020年第2期173-180,共8页Journal of Practical Oncology

摘　　要：目的探讨下颌下腺及舌下腺在内的原发性大唾液腺鳞状细胞癌(squamous cell carcinoma,SCC)预后相关因素。方法通过对美国国立癌症研究所监测、流行病学和结果数据库(Surveillance,Epidemiology,and End Results,SEER)中2004年至2016年病理诊断为原发性大唾液腺SCC患者进行回顾性分析,研究原发性大唾液腺SCC的人口统计学特征、临床病理特征及预后因素,并分析不同部位肿瘤的预后差异。结果共998例患者纳入研究,其中腮腺来源883例(88.5%)、下颌下腺来源111例(11.1%)及舌下腺来源4例(0.4%)。多数患者为白人(93.1%)、≥72岁(56.0%)、已婚(56.0%)和男性(79.8%)。多因素分析表明,年龄≥72岁、肿瘤大小≥2 cm、较高的T分期(T3~4)及远处转移是生存预后的阴性预测因素(均P<0.05),已婚、放疗、原发灶及区域淋巴结手术是预后较好的预测因素(均P<0.05)。下颌下腺SCC的5年生存率与腮腺SCC比较,差异无统计学意义(34.5%vs 41.1%,P=0.249)。在cN0患者中,选择性区域淋巴结清扫较无清扫者中位生存时间改善(62.0个月vs 17.0个月,P<0.01)。在Ⅳ期患者中,接受化疗者较无化疗者中位生存时间改善(33.0个月vs 22.0个月,P=0.005)。结论多数原发性大唾液腺SCC在确诊时即为Ⅲ期或Ⅳ期。存在高T分期及分级等高危因素的cN0患者,选择性区域淋巴结清扫可改善预后。在Ⅳ期患者中,系统性化疗可改善长期生存。Objective To investigate the prognostic factors of primary major salivary gland squamous cell carcinoma(SCC),which included the submandibular and sublingual gland SCC.Methods Patients pathologically diagnosed with primary major salivary gland SCC from the Surveillance,Epidemiology,and End Result s(SEER)database during 2004 and 2016 were reviewed.Demographic characteristics,clinicopathological features and prognostic factors were analyzed.The prognostic difference of tumors in different sites was also analyzed.Results In total,998 patients were included in the study.The primary tumor site of most patients was in the parotid gland(n=883,88.5%),followed by the submandibular gland(n=111,11.1%)and the sublingual gland(n=4,0.4%).The majority of patients were white(93.1%),≥72 years old(56.0%),married(56.0%),and male(79.8%).Multivariate analysis demonstrated that age at diagnosis≥72 years,tumor size≥2 cm,higher T-stage(T3-T4)and distant metastasis were negative predictors of survival(all P<0.05),whereas married status,radiation,and surgery of primary site and regional lymph node were positive predictors of survival(all P<0.05).The 5-year survival rate of the submandibular gland SCC was worse than that of the parotid gland SCC with no significant difference(34.5%vs 41.1%,P=0.249).In cN0 patients,the median overall survival of selective regional lymph node dissection was significantly improved than those without dissection(62.0 months vs 17.0 months,P<0.01).In stageⅣpatients,the median overall survival of patients treated with chemotherapy was significantly improved than that of those without chemotherapy(33.0 months vs 22.0 months,P=0.005).Conclusions Most primary major salivary gland SCC had stageⅢorⅣat diagnosis.In cN0 patients with high-risk factors such as higher T-stage and grade,selective regional lymph node dissection can significantly improve the prognosis.In stageⅣpatients,systemic chemotherapy can improve long-term survival.

关 键 词：涎腺肿瘤/病理学 肿瘤 鳞状细胞/病理学 存活率 预后 数据库 文献型 

分 类 号：R739.87[医药卫生—肿瘤] R730.23[医药卫生—临床医学]