嗜神经侵袭与涎腺腺样囊性癌临床特征的相关性分析

Analysis of the relationship between perineural invasion and clinical features of salivary adenoid cystic carcinoma

目的分析嗜神经侵袭(PNI)与涎腺腺样囊性癌(SACC)临床特征的相关性。方法回顾性分析1995年1月~2015年12月成都市第三人民医院口腔科收治的SACC患者临床资料,经筛选其中54例患者的各项临床特征可能与PNI关系密切,应用Logistic回归模型进行多因素分析。结果在54例SACC患者中,术前存在PNI的患者共有11例,其中8例发生在腭腺,2例在舌下腺,1例在腮腺。分析结果显示,不同性别、年龄、临床分期、肿瘤大小、淋巴结转移患者PNI比较,差异无统计学意义(P>0.05);病变部位、病理类型、生物学指标PNI差异有统计学意义(P<0.05)。术前出现PNI的患者,其术后复发率高于未出现者(P<0.05),生存率低于未出现者(P<0.05)。Logistic回归结果显示,PNI与肿瘤部位、病理类型、生物学指标密切相关(P<0.05)。结论病变部位、病理类型及生物学指标均可作为判断患者术前有无PNI的临床依据。PNI作为SACC预后的一个独立高危因素,可明显增加肿瘤术后复发率,降低患者术后生存率,术前检测患者有无PNI有助于评估肿瘤的预后。

Objective To analyze the relationship between perineural invasion （PNI） and clinical features of salivary adenoid cystic carcinoma （SACC）. Methods The clinical data of SACC patients treated in Stomatology Department of the Third People＇s Hospital of Chengdu from January 1995 to December 2015 were retrospectively analyzed. The clinical features of 54 cases potentially relevant to PNI were selected. Logistic model was used for multivariate factors analysis. Results Among 54 cases with SACC, there were 11 patients with PNI before operation, 8 cases in palatine gland, 2 cases in sublingual gland and 1 case in parotid gland. The results showed that there were no statistically significant differences in PNI among patients with different gender, ages, clinical stages, tumor sizes and lymphatic metastasis （P 〉 0.05）, but there were statistically significant differences in PNI among patients with different lesion location, pathological type and biological indicators （P 〈 0.05）. The postoperative recurrence rate of patients with PNI was higher than that of patients without PNI （P 〈 0.05）. Conversely, postoperative survival rate of patients with PNI was lower than that of patients without PNI （P 〈 0.05）. Logistic regression results showed that lesion location, pathological type and biological indicators were closely related with PNI （P 〈 0.05）. Conclusion Lesion location, pathological type and biological indicators can be used to determine whether patients have PNI or not before operation. PNI is an independent risk factor for prognosis of SACC, which can obviously increase the postoperative recurrence rate and reduce the postoperative survival rate. Preoperative examination of patients with PNI or not can be helpful for evaluation of the prognosis of the tumor.