头颈部腺样囊性癌的临床特征及预后分析

Clinical features and prognosis of adenoid cystic carcinoma of the head and neck

目的探讨头颈部腺样囊性癌(ACC)的临床特征、治疗方法及预后影响因素。方法回顾性选取2006年3月至2018年8月间空军军医大学唐都医院收治的51例接受放疗的ACC患者的临床资料和随访结果,分析手术、放疗及化疗对患者生存的影响。结果随访截至2019年12月,43例患者中位随访时间为3.5(0.4~13.3)年。截止随访日期,存活24例(55.8%),死亡19例(44.2%),局部复发9例(20.9%),远处转移15例(34.9%),肺内转移10例(66.6%)、脑转移3例(20%)、肝转移1例(6.7%)、肺及骨转移1例(6.7%)。患者死亡原因均为肿瘤复发及进展,中位无进展生存时间为5.5年,中位总生存时间为6.1年,1年、5年和10年总生存率分别为93.0%、63.0%和26.6%。单因素分析显示,是否神经侵犯和是否化疗与ACC患者的无进展生存时间相关,差异有统计学意义(P<0.05),与总生存时间无关。多因素分析表明,化疗不影响患者的无进展生存时间,神经侵犯与患者的无进展生存时间相关,差异有统计学意义(P<0.05)。结论ACC恶性程度较低,手术联合放疗可取得较好生存,但远处转移对患者生存影响较大。

Objective To investigate the clinical characteristics,treatment and prognostic factors of adenoid cystic carcinoma of the head and neck(ACC).Methods The clinical data and follow-up results of 51 patients pathologically diagnosed with ACC who received radiotherapy at Tangdu Hospital,Air Force Medical University were retrospectively analyzed from March 2006 to August 2018.The effects of surgery,radiotherapy and chemotherapy on survival were analyzed.Results These patients were followed-up through December 2019.The median follow-up period was 3.5(0.4 to 13.3)years in 43 patients.When compared to 24 live patients(55.8%)at the end of follow-up,19 patients(44.2%)died.Local recurrence occurred in 9 patients(20.9%).Distant metastasis occurred in 15 patients(34.9%).Lung metastasis occurred in 10 patients(66.6%).Brain metastasis occurred in 3 patients(20%).Liver metastasis occurred in 1 patient(6.7%).Bone and lung metastases occurred in 1 patient(6.7%).Tumor recurrence and progression were the leading causes of deaths.The median progression-free survival was 5.5 years.The overall survival was 6.1 years.The overall 1-,5-and 10-year survival rates were 93.0%,63.0%and 26.6%,respectively.Univariate analysis showed that nerve infiltration and chemotherapy were associated with progression-free survival in ACC patients(all P<0.05).Instead,no association was discovered in the overall survival.Multivariate analysis showed that nerve infiltration was associated with progressionfree survival(P<0.05),while chemotherapy did not influence it.Conclusion The degree of malignancy of adenoid cystic carcinoma of the head and neck is low.Operation combined with radiotherapy can achieve good survival.However,distant metastasis has a great impact on the survival of patients.