54例原发鼻咽涎腺型癌的临床分析

Clinical analysis on primary salivary gland type nasopharyngeal carcinoma

目的分析原发鼻咽涎腺型癌临床特点、治疗方法及预后因素。方法回顾分析1963-2006年本院收治的54例原发鼻咽涎腺型癌患者资料，其中腺样囊性癌36例、黏液表皮样癌11例、腺癌7例，单纯手术2例、单纯放疗30例、综合治疗22例（手术加放疗15例，放疗加手术7例）。8例接受化疗（术后辅助化疗1例，同期放化疗1例，复发后化疗6例）。用Logrank法单因素分析。结果随访率为89％。2、5年总生存率分别为85％、61％，无局部区域失败生存率分别为74％、55％，无远处转移生存率分别为92％、70％。治疗失败35例，其中26例局部区域失败（1例鼻咽复发加颈部淋巴结转移，23例鼻咽复发，2例颈部淋巴结转移）。发生远处转移13例（4例出现多脏器转移），其中肺转移10例、肝转移3例、骨转移2例、脑转移1例、皮下转移1例。单因素分析显示病理亚型与总生存率相关（X^2=15．29，P=0．000），而颈部淋巴结转移与无远转生存率相关（X^2=9．08，P=0．003）。结论鼻咽涎腺型癌是一种局部侵袭性强、病程发展相对较慢的疾病，治疗上推荐手术与放疗的综合治疗。

Objective To analyze the clinical characteristics, therapeutic outcomes, and prognostic factors of primary salivary gland type nasopharyngeal carcinoma （SNPC）. Methods The medical records of 54 patients with SNPC at single institution between 1963 and 2006 were reviewed, 2 patients received surgery alone, 30 patients received radiotherapy alone and 22 patients received combined modality therapy consisting of surgery （S） and radiotherapy （RT） （ S ＋ RT in 15 and RT ＋ S in 7 ）. Of them, 8 patients received chemotherapy, including post-operative adjuvant chemotherapy in 1 patient, palliative chemotherapy in 6 patients and concurrent chemotherapy in 1 patient. 36 patients had adenoid cystic carcinoma （ACC）, 11 mueoepidermoid carcinoma （ MEC）, and 7 primary traditional adenocarcinoma （AC）. The Kaplan-Meier method was used to calculate the overall survival （ OS）, locoregional failure-free survival （ LRFFS ）, and distant failure-free survival （DFFS） rates. Univariate analyses were performed using the Log-rank method. Comparisons of variables between cases were performed using Pearson chi-square test. Results The follow- up was 89%. The 2-, and 5-year overall survival rates, loco-regional failure free survival rates and distant failure free survival rates were 85% and 61% , 74% and 55% , 92% and 70%, respectively. Among the 35 patients with treatment failure, 26 patients had locoregional failure （1 in primary site and cervical lymph node ,23 in primary site and 2 in cervical lymph node） ,and 13 had distant metastasis. The lung was the most common site of metastasis （ n = 10 ）, followed by liver （ n = 3 ）, bone （ n = 2 ）, brain （ n = 1 ）, and subcutaneous tissue （ n = 1 ）. Univariate analyses indicated that histological subtypes correlated with overall survival （ Xz = 15.29, P = 0. 000 ） and cervial lymph node metastases correlated with distant failure-free survival （X2 = 9. 08 ,P = 0. 003 ）. Conclusions Primary salivary gland type nasopharyngeal carcinoma is a locally aggressive disease with a long course. The optimal treatment policy for patients with SNPC may be surgery olns radiotheraov.