76例头颈部腺样囊性癌伴肺转移患者的生存分析  

Survival Analysis of 76 Cases of Head and Neck Adenoid Cystic Carcinoma with Lung Metastasis

作　　者：余振[1] 于磊[1] 陈晓红[2] 杨兴国[1] 张葆勋[1] 于涛[1] 杜鑫 Zhen YU;Lei YU;Xiaohong CHEN;Xingguo YANG;Baoxun ZHANG;Tao YU;Xin DU(Department of Thoracic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院胸外科,北京100730 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730

出　　处：《中国肺癌杂志》2021年第6期412-419,共8页Chinese Journal of Lung Cancer

基　　金：国家外国专家局资助项目(No.[2018]52134);北京市卫生系统高层次卫生技术人才培养(No.2014-3-014)资助。

摘　　要：背景与目的头颈部腺样囊性癌(adenoid cystic carcinoma,ACC)常发生肺转移,目前ACC肺转移的研究报道不多,对于其确切的临床特征和治疗结果知之甚少,最佳治疗策略尚无共识。本研究探讨头颈部ACC肺转移的有效治疗策略、临床结局和长期预后。方法回顾性分析76例头颈部ACC肺转移患者的临床和随访资料。根据初始治疗分为手术、手术+放化疗、放化疗、支持治疗四组;根据国际肺转移分期系统(International Registry of Lung Metastases Staging System,IRLM)进行分期。采用Kaplan-Meier法、Log-rank检验比较不同治疗方式及不同IRLM分期患者的总生存期(overall survival,OS)及无进展生存期(progression-free survival,PFS)的统计学差异。结果接受手术治疗患者的OS及PFS优于支持性治疗或放疗/化疗的患者(OS:P<0.000,1;PFS:P<0.000,1);IRLM低分期的OS和PFS优于高分期患者(OS:P<0.000,1;PFS:P<0.000,1);单发肺转移、不合并胸腔积液患者具有更好的OS和PFS。结论接受手术治疗的ACC肺转移患者的远期预后与更好的OS和PFS相关。对于具备手术条件的ACC肺转移的患者,进行完整手术切除的意义高于其他治疗方案。Background and objective Adenoid cystic carcinoma(ACC)of the head and neck often develops lung metastasis.At present,there are not many research reports on ACC lung metastasis,little is known about its exact clinical features and treatment results,and there is no consensus on the best treatment strategy.This study explored the effective treatment strategies,clinical outcomes and long-term prognosis of head and neck ACC lung metastases.Methods The clinical and follow-up data of 76 patients with head and neck ACC lung metastases were retrospectively analyzed.According to the initial treatment of patients,they are divided into 4 groups:surgery,surgery+chemotherapy or radiotherapy,chemotherapy or radiotherapy and supportive treatment.The patients were staged according to the International Registry of Lung Metastases Staging System(IRLM).Kaplan-Meier method and Log-rank test were used to compare the statistical differences of overall survival(OS)and progression-free survival(PFS)of patients with different treatment methods and different IRLM stages.Results The OS and PFS of patients undergoing surgery are better than those of supportive therapy or radiotherapy and/or chemotherapy(OS:P<0.000,1;PFS:P<0.000,1).The OS and PFS of patients with low stage IRLM are better than those with high stage(OS:P<0.000,1;PFS:P<0.000,1).Patients with single lung metastasis and without pleural effusion have better OS and PFS.Conclusion The long-term prognosis of patients with lung metastasis of head and neck ACC who undergo surgery is better than other treatments,which is related to higher OS and PFS.For patients with ACC lung metastases who are operationally eligible,the significance of complete surgical resection should be higher than other treatment options.

关 键 词：腺样囊性癌 头颈部肿瘤 肺转移 

分 类 号：R734.2[医药卫生—肿瘤]