头颈部腺样囊性癌治疗预后及肺转移危险因素分析  

Prognosis of adenoid cystic carcinoma of head and neck and risk factors for lung metastasis

作　　者：王雪莲 周梦娇 马廷耀 江玲燕 赵启东 许洪波[1] 周晶[1] 李立锋[1] 孔璐[3] 陈晓红[1] Wang Xuelian;Zhou Mengjiao;Ma Tingyao;Jiang Lingyan;Zhao Qidong;Xu Hongbo;Zhou Jing;Li Lifeng;Kong Lu;Chen Xiaohong(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing 100730,China;Department of Otolaryngology,Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China;Department of Biochemistry and Molecular Biology,School of Basic Medicine,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]北京中医药大学第三附属医院耳鼻咽喉科,北京100029 [3]首都医科大学基础医学院生物化学与分子生物学系,北京100069

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第8期963-968,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金 (82173312)。

摘　　要：目的分析头颈部腺样囊性癌(adenoid cystic carcinoma,ACC)患者治疗预后及发生肺转移的危险因素。方法采用回顾性分析研究,收集2014年1月至2020年10月于首都医科大学附属北京同仁医院就诊的157例头颈部ACC患者的病例资料,其中男性72例,女性85例,发病年龄14~72岁。根据是否发生肺转移,将患者分为肺转移组(88例)和未肺转移组(69例)。应用SPSS 26.0软件行Kaplan-Meier法计算总体生存率和无进展生存率,相关临床病理因素的组间比较采用Log-rank检验来计算统计学差异。应用R Studio 1.2.5042版软件进行Cox比例风险模型多因素分析影响无肺转移生存期(lung metastasis-free survival,LMFS)的危险因素。结果患者3年、5年总体生存率分别为91.5%、85.2%,3年、5年无进展生存率分别为57.7%和34.3%。单因素分析显示原发部位、病理组织学分级、是否伴高级别转化、Ki-67、T分期、淋巴结状态是肺转移相关的危险因素(χ^(2)=11.78、10.41、4.06、4.71、5.37、16.20,P值均<0.05)。多因素Cox回归分析显示,原发灶为颌下腺或舌下腺(HR=3.53,95%CI:1.19~10.46,P<0.05)、较晚的T分期即T3-4期(HR=3.09,95%CI:1.54~6.23,P<0.05)、病理组织学Ⅱ-Ⅲ级(HR=2.47,95%CI:1.26~4.86,P<0.05)是ACC肺转移的独立危险因素。结论ACC患者易发生远处转移,其中以肺部转移为主,显著影响患者远期预后。原发部位、T分期、病理组织学分级可以作为ACC肺转移风险的预测指标。Objective To analyze the prognosis and risk factors of lung metastasis of patients with adenoid cystic carcinoma(ACC)of head and neck.Methods A retrospective study was conducted.The data of 157 patients with ACC of head and neck treated in Beijing Tongren Hospital,Capital Medical University from January 2014 to October 2020 were collected,including 72 males and 85 females,with onset age between 14 and 72 years old.According to whether lung metastasis occurred,the patients were divided into lung metastasis group(88 cases)and non-pulmonary metastasis group(69 cases).Kaplan-Meier method was used to calculate the overall survival rate and progression-free survival rate using SPSS 26.0 software.Log-rank test was used to evaluate statistically relevant clinicopathological factors.Cox proportional risk model was used in multivariate analysis for the factors affecting the lung metastasis-free survival using R Studio 1.2.5042.Results The 3-year and 5-year overall survival rates were 91.5%and 85.2%,respectively.The 3-year and 5-year progression-free survival rates were 57.7%and 34.3%,respectively.Univariate analysis showed that primary site,histological grade,high-grade transformation,Ki-67,T stage,and lymph node status were the risk factors for lung metastasis(χ^(2)=11.78,10.41,4.06,4.71,5.37,16.20,respectively,all P<0.05).Multivariate analysis showed independent risk factors for lung metastasis,including submandibular gland and sublingual gland(HR=3.53,95%CI:1.19-10.46,P<0.05),T3-4 stage(HR=3.09,95%CI:1.54-6.23,P<0.05),and GradeⅡ-Ⅲgrade(HR=2.47,95%CI:1.26-4.86,P<0.05).Conclusion Distant metastasis,mainly pulmonary metastasis,affects the long-term prognosis of patients with ACC significantly.Primary site,T stage and histopathological grade can be used as the predictors for the risk of lung metastasis.

关 键 词：头颈部肿瘤 腺样囊性癌 肺转移 危险因素 预后 

分 类 号：R739.91[医药卫生—肿瘤]