喉小涎腺癌15例临床分析

Malignant minor salivary gland tumors of the larynx

目的探讨喉小涎腺癌的临床特点、治疗及预后。方法回顾性分析中国医学科学院肿瘤医院头颈外科1959至2005年收治的15例喉小涎腺癌患者的临床资料。11例（73．3％）病变位于声门上区，4例（26．7％）病变位于声门下区。其中腺样囊性癌10例，腺癌2例，黏液表皮样癌、恶性混合瘤、基底细胞腺癌各1例。单独手术7例；手术＋放疗7例，其中6例患者行术后放疗，1例行术前放疗；1例行放疗＋化疗。治疗后4例局部复发患者行手术挽救，其中1例肺转移后行转移灶切除；1例治疗后颈转移患者行放疗。结果随访时间2～16年，中位数为8年。治疗后局部复发4例次，颈淋巴转移1例次，远处转移5例次，其中局部复发伴远处转移3例。7例患者存活3—16年，其中5例为无瘤生存，1例行单纯手术治疗，4例行手术＋放疗；4例远处转移于治疗2—10年后死亡；其余4例随访2-16年后失访。结论喉小涎腺癌很少见，其易发生局部复发和远处转移，远处转移是最主要的死亡原因。外科手术是喉小涎腺癌的主要治疗方法，手术结合放疗可望提高肿瘤局部控制率。

Objective To study the clinical features, treatment and prognosis of malignant minor salivary gland tumors of the larynx. Methods Treatment and outcome were retrospectively analyzed in a consecutive series of 15 patients with malignant minor salivary gland tumors of the larynx treated in this hospital from 1959 to 2005. Ten patients （66. 7% ） had adenoid cystic carcinoma and 2 （13.3%） had adenocarcinoma. The other three patients had mucoepidermoid carcinomas, polymorphic adenocarcinoma and base cell carcinoma respectively. Eleven（73.3% ） were located in the supraglottis and 4 （26. 7% ） in the subglottis. Fourteen had surgery （7 with adjuvant radiotherapy） and one was treated with radiotherapy plus chemotherapy. Five patients were found to have recurrent disease, 4 of whom underwent salvage surgery, 1 of whom had pallitation radiotherapy. Results With a median follow - up of 8 years （ ranging from 2 to 16 years）, 7 patients are alive. Five patients have no evidence of disease, 1 of whom had surgery alone ,4 of whom were treated with surgery plus radiotherapy. Four patients died of distant metastases in a range of 2 to 10 years. The other 4 patients were lost to follow-up after treatment（ ranging from 2 years to 16 years）. Seven patients developed recurrent disease, 1 of whom had local recurrence alone, 1 had regional recurrence alone, 2 had distant metastases alone, and 3 had local and distant metastases. Conclusions Minor salivary gland carcinomas of the larynx are rare and they are prone to the local recurrence and the distant metastasis in advanced stage. Distant metastases remain the principal cause of treatment failure. Surgery is the primary treatment modality used in most cases and the radiotherapy combining surgery has better local and regional control rate.