背景:这项研究调查了18年期间在单一机构治疗腮腺癌患者的临床结果,专注于诊断,治疗,和生存。
方法:本研究对象为1999年9月至2017年8月在我科治疗18年的171例腮腺癌患者。第一阶段有19名患者,65例II期患者,22例III期患者,和65例IV期患者。症状,术前诊断,淋巴结转移,存活率,预后因素,和免疫组织学检查结果进行了调查。
结果:只有34%的患者可以通过细针穿刺细胞学检查术前诊断组织学分级。而72%的组织学分级通过冰冻切片活检正确确定。淋巴结转移的总发生率为29%,59%的患者患有高级别癌症,只有6%的患者患有低/中度肿瘤。I期患者的疾病特异性5年生存率为100%,第二阶段为95.2%,第三阶段为70.4%,第四阶段为45.1%。多因素分析显示病理分级是最重要的预后因素。免疫组织学研究显示,HER-2或雄激素受体阳性肿瘤患者的预后明显较差。
结论:尽管高级别肿瘤是最重要的预后因素,术前分级诊断并不总是准确的.由于晚期癌症预后差,对手术和放射治疗的反应有限,开发新的治疗策略,例如针对HER-2和AR的分子靶向治疗,是必需的。
BACKGROUND: This study investigated the clinical outcomes of patients with parotid carcinoma at a single institution during an 18-year period, with the focus on diagnosis, treatment, and survival.
METHODS: The subjects were 171 patients with parotid carcinoma treated at our department during the 18-year period from September 1999 to August 2017. There were 19 patients in stage I, 65 patients in stage II, 22 patients in stage III, and 65 patients in stage IV. The symptoms, preoperative diagnosis, node metastasis, survival rate, prognostic factors, and immunohistological findings were investigated.
RESULTS: Preoperative diagnosis of the histological grade by fine-needle aspiration cytology was only possible in 34% of the patients, while the histological grade was correctly determined by frozen section biopsy in 72%. The overall frequency of lymph node metastasis was 29%, with 59% in patients with high-grade carcinoma and only 6% in those with low-/intermediate-grade tumors. The disease-specific 5-year survival rate was 100% for patients in stage I, 95.2% in stage II, 70.4% in stage III, and 45.1% in stage IV. Multivariate analysis showed that the pathological grade was the most important prognostic factor. Immunohistological investigation showed patients with HER-2 or androgen receptor-positive tumors had a significantly worse prognosis.
CONCLUSIONS: Although a high-grade tumor is the most important prognostic factor, preoperative diagnosis of the grade was not always accurate. Since advanced cancer has a poor prognosis with a limited response to surgery and radiation therapy, development of new treatment strategies, such as molecular-targeting therapies directed against HER-2 and AR, is required.