目的:颈清扫术在原发性腮腺癌中的作用和范围存在争议。在这里,我们描述了腮腺癌淋巴结转移的模式。
方法:回顾性分析。
方法:国家癌症数据库。
方法:选择6种最常见的腮腺癌组织学亚型的患者。主要结果是通过Cox分析评估的阳性淋巴结水平分布和总生存期。次要结局包括延长淋巴结受累(≥3个淋巴结或IV/V级受累)的预测因素,通过逻辑回归。
结果:六千九百七十七例腺泡细胞癌患者,腺癌,腺样囊性癌,多形性腺瘤(CExPA),粘液表皮样癌,和唾液腺导管癌(SDC)被包括在内。在cN0患者中,低级别肿瘤患者中有8.2%的淋巴结隐匿性转移,而高级别肿瘤患者中有30.9%。选择性颈淋巴结清扫术与总生存获益无关(调整后的风险比:1.10;0.94-1.30,p=.238)。在cN+肿瘤中,CExPA(比值比[OR]:1.88,1.05-3.39,p=.034)和高级别病理学(OR:3.03,1.87-4.93,p<.001)可预测具有≥3个病理节点。CExPA(OR:2.13,1.22-3.72,p=.008),腺癌(OR:1.60,1.11-2.31,p=.013),SDC(OR:1.92,1.17-3.14,p<0.01),和高级别病理(OR:3.61,2.19-5.97,p<.001)可预测IV/V级颈部受累。
结论:在腮腺恶性肿瘤中,淋巴结转移的分布取决于组织学和分级。高级别肿瘤和某些组织学(SDC和腺癌)隐匿性淋巴结的发生率较高。对于淋巴结阳性的高级别肿瘤,也应考虑综合颈淋巴结清扫术,SDC,和腺癌。
The role and extent of neck dissection in primary parotid cancer are controversial. Herein, we characterize patterns of lymph node metastasis in parotid cancer.
Retrospective analysis.
National Cancer Database.
Patients with the 6 most common histologic subtypes of parotid cancer were selected. Primary outcomes were the distribution of positive lymph nodes by level and overall survival assessed by Cox analysis. Secondary outcomes included predictors of extended lymph node involvement (≥3 lymph nodes or Level IV/V involvement), via logistic regression.
Six thousand nine hundred seventy-seven patients with acinic cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma (CExPA), mucoepidermoid carcinoma, and salivary duct carcinoma (SDC) were included. Among cN0 patients, 8.2% of low-grade tumor patients had occult nodal metastasis versus 30.9% in high-grade tumor patients. Elective neck dissection was not associated with an overall survival benefit (adjusted hazard ratio: 1.10; 0.94-1.30, p = .238). Among cN+ tumors, CExPA (odds ratio [OR]: 1.88, 1.05-3.39, p = .034) and high-grade pathology (OR: 3.03, 1.87-4.93, p < .001) were predictive of having ≥3 pathologic nodes. CExPA (OR: 2.13, 1.22-3.72, p = .008), adenocarcinoma (OR: 1.60, 1.11-2.31, p = .013), SDC (OR: 1.92, 1.17-3.14, p < .01), and high-grade pathology (OR: 3.61, 2.19-5.97, p < .001) were predictive of Level IV/V neck involvement.
In parotid malignancy, nodal metastasis distribution is dependent on histology and grade. High-grade tumors and certain histologies (SDC and adenocarcinoma) had a higher incidence of occult nodes. Comprehensive neck dissection should also be considered for node-positive high-grade tumors, SDC, and adenocarcinoma.