Abstract：
OBJECTIVE: Distant metastases (DM) are the primary cause of treatment failure and death of patients with salivary gland carcinomas (SGC). The purpose of present study was to evaluate factors predictive on DM development in a cohort of patients with high-grade salivary gland carcinomas.
METHODS: This was a retrospective cohort study of consecutive patients surgically treated with curative intention at the authors\' institution from January 1993 to December 2018. Outcomes evaluated were overall survival (OS), disease specific survival (DSS), recurrence free survival (RFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS).
RESULTS: A total of 213 patients, 117 males (55%) and 96 females (45%), were included in the study. Parotid gland malignancies accounted for 56% of all cases. Adenoid cystic carcinoma (119 cases; 56%) was the most common tumor type. Cumulative OS for the 5-and 10-year follow-up period was 80% and 58% respectively. DM occurred with 75 patients (35%). The most common locations for DM were lung (55 cases; 73%) and liver (12 cases; 16%). Pathological nodal status, particularly the number of metastatic nodes, was the independent prognostic factor for OS, DSS, RFS and DMFS.
CONCLUSIONS: Number of metastatic lymph nodes, instead of extranodal extension and largest nodal diameter, was the contributing factor related to DMFS. Since the main function of staging system is to predict outcomes, the significance of extranodal extension and nodal dimension in salivary gland cancer staging system requires further clarification. The elective neck dissection could be considered therapeutic approach for high-grade SGC since occult metastases were detected in 33% of cases.
METHODS: This was a retrospective cohort study of consecutive patients surgically treated with curative intention at the authors\' institution from January 1993 to December 2018. Outcomes evaluated were overall survival (OS), disease specific survival (DSS), recurrence free survival (RFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS).
RESULTS: A total of 213 patients, 117 males (55%) and 96 females (45%), were included in the study. Parotid gland malignancies accounted for 56% of all cases. Adenoid cystic carcinoma (119 cases; 56%) was the most common tumor type. Cumulative OS for the 5-and 10-year follow-up period was 80% and 58% respectively. DM occurred with 75 patients (35%). The most common locations for DM were lung (55 cases; 73%) and liver (12 cases; 16%). Pathological nodal status, particularly the number of metastatic nodes, was the independent prognostic factor for OS, DSS, RFS and DMFS.
CONCLUSIONS: Number of metastatic lymph nodes, instead of extranodal extension and largest nodal diameter, was the contributing factor related to DMFS. Since the main function of staging system is to predict outcomes, the significance of extranodal extension and nodal dimension in salivary gland cancer staging system requires further clarification. The elective neck dissection could be considered therapeutic approach for high-grade SGC since occult metastases were detected in 33% of cases.
摘要：
目的：远处转移（DM）是唾液腺癌（SGC）患者治疗失败和死亡的主要原因。本研究的目的是评估高级别唾液腺癌患者队列中DM发展的预测因素。
方法：这是一项回顾性队列研究，对作者机构于1993年1月至2018年12月期间接受有治愈意向手术治疗的连续患者进行了研究。评估的结果是总生存期（OS），疾病特异性生存率（DSS），无复发生存率（RFS），局部无复发生存率（LRFS）和无远处转移生存率（DMFS）。
结果：共有213名患者，117名男性（55％）和96名女性（45％），包括在研究中。腮腺恶性肿瘤占所有病例的56%。腺样囊性癌（119例；56%）是最常见的肿瘤类型。5年和10年随访期的累积OS分别为80%和58%。75例（35%）患者发生DM。DM最常见的位置是肺（55例；73％）和肝（12例；16％）。病理淋巴结状态，特别是转移性淋巴结的数量，是OS的独立预后因素，DSS,RFS和DMFS。
结论：转移性淋巴结的数量，而不是结外延伸和最大结节直径，是与DMFS相关的促成因素。由于分期系统的主要功能是预测结果，结外延伸和结节尺寸在唾液腺癌分期系统中的意义需要进一步澄清。由于在33％的病例中检测到隐匿性转移，因此选择性颈淋巴结清扫术可被视为高级SGC的治疗方法。
方法：这是一项回顾性队列研究，对作者机构于1993年1月至2018年12月期间接受有治愈意向手术治疗的连续患者进行了研究。评估的结果是总生存期（OS），疾病特异性生存率（DSS），无复发生存率（RFS），局部无复发生存率（LRFS）和无远处转移生存率（DMFS）。
结果：共有213名患者，117名男性（55％）和96名女性（45％），包括在研究中。腮腺恶性肿瘤占所有病例的56%。腺样囊性癌（119例；56%）是最常见的肿瘤类型。5年和10年随访期的累积OS分别为80%和58%。75例（35%）患者发生DM。DM最常见的位置是肺（55例；73％）和肝（12例；16％）。病理淋巴结状态，特别是转移性淋巴结的数量，是OS的独立预后因素，DSS,RFS和DMFS。
结论：转移性淋巴结的数量，而不是结外延伸和最大结节直径，是与DMFS相关的促成因素。由于分期系统的主要功能是预测结果，结外延伸和结节尺寸在唾液腺癌分期系统中的意义需要进一步澄清。由于在33％的病例中检测到隐匿性转移，因此选择性颈淋巴结清扫术可被视为高级SGC的治疗方法。
