腮腺黏液表皮样癌预后及影响因素分析

A clinicopathological analysis of parotid mucoepidermoid carcinomas: prognosis and influencing factors

目的分析腮腺黏液表皮样癌的治疗效果及预后相关因素。方法回顾性分析1992年1月～2008年6月我院治疗的81例腮腺黏液表皮样癌患者资料,应用SPSS13.0软件包统计生存率及预后相关因素。结果中位随访时间39个月(3～168个月),81例患者5年总生存率85.5%,疾病特异生存率90.8%,淋巴结转移率16.0%(13/81),隐匿性转移率为9.6%(7/73)。5年局部和区域控制率分别为90.9%和93.9%。单因素分析中T分级、N分级、病理类型、手术方式、颈淋巴结清扫术、远处转移及再次治疗对预后有统计学意义,而多因素分析中病理分化程度(OR=15.080,95%CI=3.934～57.801,P<0.001)是唯一的独立预后因素,低分化癌的颈部复发率和远处转移率明显高于高中分化者。结论病理分化程度是腮腺黏液表皮样癌唯一的独立预后因素,对于低分化癌患者应采取积极的综合治疗以降低颈部复发率及远处转移率。

OBJECTIVE To analyze the prognosis of parotid mucoepidermoid carcinoma（MEC）and clinicopahtological influencing factors. METHODS Eightyone patients with parotid MEC treated in our hospital from January 1992 to June 2008 were retrospectively reviewed. Survival rates and prognostic factors were calculated with SPSS 13.0 software. RESULTS With a median follow-up 39 months, 5-year overall survival rate（OS）and disease-specific survival rate（DSS） of the whole group patients were 85.5% and 90.8%, respectively. Sixteen percent（13/81）had cervical lymph node metastasis（LNM）and 9.6%（7/73） patients had occult LNM. Five-year local and regional control rates were 90.9% and 93.9%, respectively. T stage, N stage, pathological differentiation, surgical extent, neck dissection, distant metastasis and complete parotidectomy were statistical signi？cant factors in univariate analysis. In Cox regression pathological differentiation （OR=15.080,95%CI=3.934～57.801,P0.001）was the only independent prognostic factor. Poorly differentiated MEC had higher cervical and distant metastasis rates. CONCLUSION Pathological differentiation was the only independent prognostic factor for parotid MEC. For patients with poorly differentiated type aggressive combined therapy was indicated to decrease cervical and distant metastasis.