背景:粘液表皮样癌(MEC)是一种罕见的头颈部恶性肿瘤;然而,它占唾液腺肿瘤的大部分。这项研究使用了基于人群的国家注册表来描述影响主要唾液腺MEC患者生存的治疗前和治疗相关预后因素。据我们所知,这是一项规模最大的基于人群的研究,研究了主要唾液腺MEC总体生存率和病因特异性生存率的预测因子.
目的:确定影响主要唾液腺MEC患者总生存期(OS)和病因特异性生存期(CSS)的预后因素。
方法:我们使用了监测,国家癌症研究所的流行病学和最终结果数据库,以调查可能影响被诊断为主要唾液腺粘液表皮样癌的患者的生存的各种因素。研究了1975-2016年期间诊断为主要唾液腺MEC的2210例患者。主要终点是OS和CSS。Cox回归分析用于对诊断时的年龄等临床变量进行单变量和多变量分析。诊断年,性别,种族,肿瘤大小,舞台,grade,有或没有手术切除的治疗,和辅助放射治疗。
结果:总共2210例诊断为主要唾液腺MEC的患者符合纳入标准。在这项研究中,95%的患者接受了手术切除,41%的患者接受了辅助放射治疗。一级的中位OS时间,II,III/IV为401个月(±48.25,95CI),340mo(±33.68,95CI)和55mo(±11.05,95CI),分别。单变量分析显示,缺乏手术切除与OS降低相关[风险比(HR)4.26,P<0.0001],与区域和远处疾病相比,局部疾病患者的OS改善(HR分别为3.07和6.96,P<0.0001)。此外,单因素分析表明,男性,诊断时年龄超过50岁,III级肿瘤,肿瘤大小增加与OS恶化相关(P<0.0006)。CSS的单变量分析类似地显示,缺乏手术切除和III级癌症导致CSS降低(HR分别为4.37和5.44,P<0.0001)。多因素分析证实,年龄增长,在10岁年龄段,肿瘤晚期,增加肿瘤大小,Ⅲ级癌,男性,缺乏手术切除与OS和CSS的统计学显著降低相关(P<0.04)。值得注意的是,多变量分析显示,辅助放射治疗的使用与OS或CSS的改善无关。
结论:多变量分析表明年龄增加,肿瘤晚期,增加肿瘤大小,Ⅲ级癌,男性,缺乏手术切除与OS和CSS降低相关(P<0.04)。
BACKGROUND: Mucoepidermoid carcinoma (MEC) is a rare malignancy of the head and neck; however, it accounts for a majority of the tumors of the salivary glands. This study used a national population-based registry to describe the pre-treatment and treatment-related prognostic factors that influence survival in patients with MEC of the major salivary glands. To our knowledge, this is the largest population-based study examining predictors of both overall and cause-specific survival of MEC of the major salivary glands.
OBJECTIVE: To identify prognostic factors influencing overall survival (OS) and cause-specific survival (CSS) of patients with MEC of the major salivary glands.
METHODS: We used the Surveillance, Epidemiology and End-Results Database of the National Cancer Institute to investigate a variety of factors that could influence survival of patients diagnosed with mucoepidermoid carcinoma of the major salivary glands. A total of 2210 patients diagnosed with MEC of the major salivary glands during the years of 1975-2016 were studied. The primary endpoints were OS and CSS. Cox regression analysis was used to perform univariate and multivariate analyses of clinical variables such as age at diagnosis, diagnosis year, sex, race, tumor size, stage, grade, treatment with or without surgical excision, and adjuvant radiotherapy treatment.
RESULTS: A total of 2210 patients diagnosed with MEC of the major salivary glands met inclusion criteria. In this study, 95% of patients underwent surgical excision and 41% received adjuvant radiation therapy. Median OS time for Grade I, II, and III/IV was 401 mo (± 48.25, 95%CI), 340 mo (± 33.68, 95%CI) and 55 mo (± 11.05, 95%CI), respectively. Univariate analysis revealed that lack of surgical excision was associated with decreased OS [hazard ratio (HR) 4.26, P < 0.0001] and that patients with localized disease had improved OS compared to both regional and distant disease (HR 3.07 and 6.96, respectively, P < 0.0001). Additionally, univariate analysis demonstrated that male sex, age over 50 at diagnosis, Grade III tumors, and increasing tumor size were associated with worsened OS (P < 0.0006). Univariate analysis of CSS similarly revealed that lack of surgical excision and Grade III carcinoma conferred decreased CSS (HR 4.37 and 5.44, respectively, P < 0.0001). Multivariate analysis confirmed that increasing age, in 10-year age bands, advanced tumor stage, increasing tumor size, Grade III carcinoma, male sex, and lack of surgical excision were associated with a statistically significant decrease in OS and CSS (P < 0.04). Of note, multivariate analysis revealed that the use of adjuvant radiation therapy was not associated with improved OS or CSS.
CONCLUSIONS: Multivariate analysis demonstrated increasing age, advanced tumor stage, increasing tumor size, Grade III carcinoma, male sex, and lack of surgical excision were associated with decreased OS and CSS (P < 0.04).