52例腮腺恶性肿瘤患者的临床分析

An analysis of 52 patients of malignant parotid gland tumor

背景与目的：大涎腺中腮腺肿瘤的发病率最高。腮腺恶性肿瘤的病理学特征复杂、临床表现和预后也各有差异。本研究旨在分析腮腺恶性肿瘤的临床特点、治疗方法及预后因素。方法：回顾性分析1989—2011年暨南大学第二临床医学院肿瘤放疗科收治的52例腮腺原发恶性肿瘤患者资料，治疗方式均为手术加术后放疗。病理亚型有：黏液表皮样癌、腺样囊性癌、腺泡细胞癌、肌上皮癌、腺癌、鳞癌和未分化癌。结果：中位随访期62个月（14～191个月）。3年和5年局部控制率分别为98．1％和94．2％；3年和5年总生存率分别为89．0％和86．3％；3年和5年无局部区域复发生存率分别为90．3％和87．1％。单因素分析显示，T分期、淋巴结转移状况、临床分期、病理亚型、病理分化程度、手术方式及放射治疗剂量对预后有统计学意义。多因素分析显示，临床分期和病理分化程度是独立预后因素。结论：腮腺恶性肿瘤手术加术后放疗的综合治疗模式值得推荐，临床分期和病理分化程度是腮腺恶性肿瘤的独立预后因素。

Background and purpose： The incidence of parotid gland tumor is highest in the major salivary gland. Malignant parotid gland tumor is of complex pathology features, different clinical manifestation and prognosis. We study the clinical characteristics, treatment and prognostic factors of malignant parotid gland tumor. Methods： From 1989 to 2011, 52 patients of primary malignant parotid gland tumor were retrospectively reviewed. All cases were treated with surgery and radiation. Among these cases, 23 cases were mucoepidermoid carcinoma, 14 cases were adenoidcystic carcinoma, 5 cases were acinic cell carcinoma, 6 cases were myoepithelial carcinoma, 1 case was adenocarcinoma, 2 cases were squamous carcinoma and 1 case was undifferentiated carcinoma. Results： The median follow-up was 62 months （14-191 months）. The 3-year and 5-year local control rate were 98.1% and 94.2%, respectively. The 3-year and 5-year overall survival rate were 89.0% and 86.3%, respectively. The 3-year and 5-year local regional recurrence-free survival rates were 90.3% and 87.1%, respectively. The univariate analysis revealed that T stage, lymph nodes metastatic status, clinical stage, histological subtype, pathological differentiation, operation pattern and radiotherapy dose were of statistic significance to the prognosis. And multivariate analysis showed that clinical stage and pathological differentiation were the independent prognostic factors of malignant parotid gland tumor. Conclusion： The combination therapy of surgery and radiation in malignant parotid gland tumor is deserved to recommend, and clinical stage and pathological differentiation are the independent prognostic factors.