涎腺腺泡细胞癌的临床病理特征及其与预后的相关性

Correlation between clinicopathological features and prognosis of acinic cell carcinoma of salivary glands

目的观察涎腺腺泡细胞癌(ACC)的临床病理特征,并分析其与预后的相关性。方法回顾性分析71例ACC患者的临床病理特征和随访资料,根据患者生存情况将完成随访的56例患者分为死亡组(n=18)和未死亡组(n=38)。对临床病理特征与ACC患者死亡的相关性进行分析。采用Cox回归比例风险模型进行多因素分析,推测影响ACC患者预后的危险因素。结果 71例ACC患者中,发病年龄为40~60岁、病程﹤5年、肿块无压痛、质地中等、肿物边界清晰、移动度尚可、无淋巴结转移,发病部位为腮腺、肿瘤直径为2~4 cm、临床分期为Ⅰ期、术后未接受化疗的患者所占比例较多;在完成随访的56例患者中,复发率为35.71%、区域淋巴结转移率为21.43%、肺部转移率为10.71%、死亡率为32.14%,术后1年、3年、5年及5年以上的生存率分别为96.43%、92.86%、82.14%及67.86%;死亡组和未死亡组患者的发病年龄、肿物边界情况、淋巴结转移情况、发病部位及临床分期比较,差异有统计学意义(P﹤0.05);多因素Cox回归分析显示:发病年龄、临床分期、淋巴结转移是影响ACC患者预后的危险因素(P﹤0.05)。结论 ACC以40~60岁的患者居多,多见于腮腺,临床缺乏特征性表现;复发率低、5年内生存率较高;发病年龄、临床分期、淋巴结转移是影响ACC患者预后的危险因素。

Objective To observe the clinicopathological features of acinic cell carcinoma（ACC） of salivary glands,and analyze their correlation with prognosis. Method The clinicopathological features and follow-up data of 71 patients with ACC were reviewed retrospectively. 56 subjects who had completed follow-up period were divided into death group（n=18） and non-death group（n=38） according to the survival results. Correlation analysis was conducted to test the relation between clinicopathological features and the deaths of ACC patients. Multivariate analysis by Cox proportional-hazard model was used to analyze the risk factors for prognosis in ACC patients. Result A high percentage of the 71 cases of patients had an onset age of 40 to 60, a disease duration 5 years, lumps without tenderness, medium texture, clear boundaries around lumps, satisfactory mobility, no lymph node metastasis observed, parotid gland as disease onset region, tumor diameter of 2 to 4 cm, clinical stage Ⅰ and not undergone postoperative chemotherapy; among the 56 patients who had completed follow-up period, the recurrence rate was 35.71%, the rate of regional lymph node metastasis was21.43%, the rate of lung metastasis was 10.71%, the death rate was 32.14%, and the postoperative 1-, 3-, 5-and over 5-year survival rate was 96.43%, 92.86%, 82.14% and 67.86% respectively; there were statistically significant differences in onset age, lump boundaries, lymph node metastasis, disease onset region and clinical stage between death group and non-death group（P〈0.05）; multivariate Cox analysis results showed that onset age, clinical stage, lymph node metastasis were risk factors for the prognosis of ACC patients（P〈0.05）. Conclusion ACC is most common in patients aged 40 to60, often located in parotid gland and lack of characteristic clinical manifestations; the recurrence rate of ACC is low and the survival rate within 5 years is high; the onset age, clinical stage and lymph node metastasis are the risk factors for the prognosis of ACC patients.