PDF(Pubmed)
Abstract：
BACKGROUND: Salivary duct carcinomas (SDC) are a rare and aggressive subtype of salivary gland neoplasm. They can present with distinct immunoprofiles, such as androgen receptor (AR) and HER-2/Neu-positivity. To date, no consensus exists on how to best manage this entity.
METHODS: All patients diagnosed with nonmetastatic AR+ SDC of the parotid from 2013 to 2019 treated with curative intent were included. Immunologic tumor profiling was conducted using 24 distinct markers. Kaplan-Meier analyses were used to estimate locoregional recurrence (LRR), distant control, and overall survival (OS).
RESULTS: Fifteen patients were included. Nine (60%) patients presented with T4 disease and eight (53%) had positive ipsilateral cervical lymphadenopathy. Ten (67%) patients underwent trimodality therapy, including surgery followed by adjuvant radiation and concurrent systemic therapy. The median follow-up was 5.5 years (interquartile range, 4.8-6.1). The estimated 5-year rates of LRR, distant progression, and OS were 6%, 13%, and 87%, respectively.
CONCLUSIONS: Despite only including AR+ SDC of the parotid, immunoprofiles, such as expression of HER-2, were highly variable, highlighting the potential to tailor systemic regimens based on individual histologic profiles in the future. Studies with larger patient numbers using tumor-specific molecular profiling and tumor heterogeneity analyses are justified to better understand the biology of these tumors. Molecularly informed treatment approaches, including the potential use of AR- and HER-2/Neu-directed therapies upfront in the definitive setting, may hold future promise to further improve outcomes for these patients.
METHODS: All patients diagnosed with nonmetastatic AR+ SDC of the parotid from 2013 to 2019 treated with curative intent were included. Immunologic tumor profiling was conducted using 24 distinct markers. Kaplan-Meier analyses were used to estimate locoregional recurrence (LRR), distant control, and overall survival (OS).
RESULTS: Fifteen patients were included. Nine (60%) patients presented with T4 disease and eight (53%) had positive ipsilateral cervical lymphadenopathy. Ten (67%) patients underwent trimodality therapy, including surgery followed by adjuvant radiation and concurrent systemic therapy. The median follow-up was 5.5 years (interquartile range, 4.8-6.1). The estimated 5-year rates of LRR, distant progression, and OS were 6%, 13%, and 87%, respectively.
CONCLUSIONS: Despite only including AR+ SDC of the parotid, immunoprofiles, such as expression of HER-2, were highly variable, highlighting the potential to tailor systemic regimens based on individual histologic profiles in the future. Studies with larger patient numbers using tumor-specific molecular profiling and tumor heterogeneity analyses are justified to better understand the biology of these tumors. Molecularly informed treatment approaches, including the potential use of AR- and HER-2/Neu-directed therapies upfront in the definitive setting, may hold future promise to further improve outcomes for these patients.
摘要：
背景：涎管癌（SDC）是一种罕见且侵袭性的涎腺肿瘤亚型。它们可以呈现不同的免疫谱，如雄激素受体（AR）和HER-2/Neu阳性。迄今为止,关于如何最好地管理这个实体没有共识。
方法：纳入2013年至2019年诊断为腮腺非转移性AR+SDC的所有患者。使用24种不同的标志物进行免疫肿瘤谱分析。Kaplan-Meier分析用于估计局部复发（LRR），远程控制,总生存率（OS）。
结果：纳入15例患者。9例（60％）患者患有T4疾病，8例（53％）同侧颈淋巴结肿大阳性。10例（67%）患者接受了三联疗法，包括手术后辅助放疗和同步全身治疗。中位随访时间为5.5年(四分位距，4.8-6.1)。LRR的估计5年期利率，遥远的进展，OS为6%，13%,87%,分别。
结论：尽管仅包括腮腺的AR+SDC，免疫谱，如HER-2的表达，是高度可变的，强调了未来根据个体组织学特征定制系统治疗方案的潜力。使用肿瘤特异性分子谱分析和肿瘤异质性分析对更多患者进行的研究是合理的，以更好地了解这些肿瘤的生物学。分子知情的治疗方法，包括在确定的环境中预先使用AR和HER-2/Neu指导的疗法，未来有望进一步改善这些患者的预后.
方法：纳入2013年至2019年诊断为腮腺非转移性AR+SDC的所有患者。使用24种不同的标志物进行免疫肿瘤谱分析。Kaplan-Meier分析用于估计局部复发（LRR），远程控制,总生存率（OS）。
结果：纳入15例患者。9例（60％）患者患有T4疾病，8例（53％）同侧颈淋巴结肿大阳性。10例（67%）患者接受了三联疗法，包括手术后辅助放疗和同步全身治疗。中位随访时间为5.5年(四分位距，4.8-6.1)。LRR的估计5年期利率，遥远的进展，OS为6%，13%,87%,分别。
结论：尽管仅包括腮腺的AR+SDC，免疫谱，如HER-2的表达，是高度可变的，强调了未来根据个体组织学特征定制系统治疗方案的潜力。使用肿瘤特异性分子谱分析和肿瘤异质性分析对更多患者进行的研究是合理的，以更好地了解这些肿瘤的生物学。分子知情的治疗方法，包括在确定的环境中预先使用AR和HER-2/Neu指导的疗法，未来有望进一步改善这些患者的预后.
