头颈部唾液腺腺样囊性癌术后调强放疗预后分析

Clinical efficacy and prognosis of adjuvant radiotherapy for adenoid cystic carcinoma of head and neck salivary gland

目的探讨头颈部唾液腺腺样囊性癌(ACC)的综合治疗模式及预后因素。方法收集2016—2018年间上海交通大学医学院附属第九人民医院放疗科收治的头颈部唾液腺ACC完成术后放疗患者资料进行回顾性分析。Kaplan-Meier法生存分析,log-rank检验单因素预后分析,Cox模型多因素分析。结果共166例患者被纳入研究,其中男70例,女96例,平均年龄53岁(18~71岁)。中位随访期31.2个月(8.6~63.1个月)。接受根治手术者66例(肿瘤床外跨解剖区域扩大切除,追求各类切缘阴性),接受保守手术者100例(仅病灶扩大切除,不追求神经切缘阴性)。术后放疗中位剂量66 Gy(54~70 Gy)。有73例患者因切缘阳性或近切缘,9例患者因颈淋巴结转移行TP方案同期化疗。全组患者3年和5年总生存(OS)率、局部区域无复发生存(LRRFS)率、无远处转移生存(DMFS)率、无进展生存(PFS)率分别为95%和95%、93%和93%、74%和66%、73%和65%。全组病例共40例出现治疗失败,其中原发灶复发7例,区域淋巴结复发5例,远处转移38例。T_(3)-T_(4)期、N(+)、Ⅳ期、病理分型实体型、Ki67高表达、神经侵犯是影响PFS、DMFS的预后不良因素,多因素分析只有病理分型是影响OS、LRRFS、PFS、DMFS的独立预后因素。结论头颈部唾液腺ACC术后辅助调强放疗提高了局控率,推荐放疗剂量≥66 Gy。实体型病理分型是最重要的预后不良因素。

Objective To investigate the optimal treatment modalities and prognostic factors of adenoid cystic carcinoma of the head and neck salivary gland.Methods From January 2016 to December 2018,clinical data of 166 patients with adenoid cystic carcinoma of the head and neck salivary gland who received postoperative radiotherapy at Department of Radiation Oncology of the Ninth People′s Hospital of Shanghai Jiao Tong University School of Medicine were retrospectively analyzed.The survival analysis was performed by Kaplan-Meier method.Univariate prognostic analysis was conducted by log-rank test.Multivariate prognostic analysis was carried out by Cox proportional hazard regression model.Results Among 166 enrolled patients,70 cases were male and 96 female with an average age of 53 years(18 to 71 years).The median follow-up time was 31.2 months(8.6-63.1 months).Sixty-six patients underwent radical surgery(extended resection across the anatomical areas outside the tumor bed,pursuing negative margins of various resections),and the remaining 100 patients underwent conservative surgery(only extended resection of lesions,not pursuing negative nerve resection margins).The median dose of postoperative radiotherapy was 66 Gy(54-70 Gy).Seventy-three patients were treated with TP regime due to positive or close margins and 9 cases of cervical lymph node metastasis.The 3-and 5-year overall survival(OS),locoregional recurrence-free survival(LRRFS),distant metastasis-free survival(DMFS),progression-free survival(PFS)rates were 95%and 95%,93%and 93%,74%and 66%,73%and 65%,respectively.Seven patients experienced primary lesion recurrence,5 cases of regional lymph node recurrence and 38 cases of distant metastasis.T_(3)-T_(4) stage,lymph nodes(+),stage IV,solid pathologic subtype,Ki-67≥10%and perineural invasion were associated with worse PFS and DMFS.Multivariate analysis demonstrated that only solid pathologic subtype was the independent prognostic factor of OS,LRRFS,PFS and DMFS.Conclusions The local control rate of salivary gland adenoid cystic carcinoma can be improved by postoperative intensity-modulated radiotherapy(IMRT)with a recommended dose of≥66 Gy.Solid pathologic subtype is the most important adverse prognostic factor.