腮腺恶性肿瘤的临床特征及预后因素分析

Clinical Characteristics and Prognostic Factors of Malignant Tumors of Parotid Gland

目的探讨腮腺恶性肿瘤的临床特征及预后因素。方法回顾性分析49例腮腺肿瘤患者的临床资料。Kaplan-Meier分析特定疾病,无病,转移(区域及远)无瘤生存率。采用对数秩和Wilcoxon检验来比较存活曲线。采用Cox比例风险模型对临床特征进行多变量分析。结果腮腺恶性肿瘤,c T4分期是最显著的临床预后因素(P=0.0055,对数秩),亦为面部神经受累的临床特征。49例腮腺肿瘤患者2年,5年的总生存率分别为85%,72%。2年和5年疾病特异性生存率为93%和89%,Ⅶ神经切除和没有切除患者(5年生存率分别为92%和79%)之间的5年生存率没有差异。疾病特异性存活最显著因素为阳性/闭合边缘(P=0.01,对数秩)及诊断阶段的c T4分期(P=0.0055,对数秩)。涎腺恶性肿瘤比其他大多数头颈部位肿瘤更易发生远处转移。结论本研究建议在解剖和手术治疗腮腺恶性肿瘤中保持正常的第七颅神经。

Objective To evaluate the clinical characteristics and prognostic factors of malignant tumors of parotid gland. Methods Clinical data of 49 cases of parotid tumors were retrospectively analyzed. Specific diseases,disease-free,metastasis( regional and distant),tumor-free survival were analyzed by Kaplan-Meier. Log-rank and Wilcoxon tests were used to compare survival curves. Clinical features received multivariate analysis by Cox proportional hazards model. Results In parotid tumor,c T4 staging was the most significant prognostic factor( P = 0. 0055,log-rank),it was also the clinical features of facial nerve involvement. 2-,5-year overall survival rates of 49 cases of parotid tumors were 85%,72%. 2-,5-year disease-specific survival rates were 93% and 89%,There was no difference in 5-year survival rate between Ⅶ nerve resection and no resection patients( 5-year survival rates were 92% and 79%). The most significant disease-specific survival factors were the positive / closing edge( P = 0. 01,log-rank) and the diagnostic phase of c T4 staging( P = 0. 0055,log-rank). Salivary gland cancer were more likely to have distant metastasis than most other head and neck cancer. Conclusion Ⅶ cranial nerve should be preserved during anatomical and surgical treatment of malignant tumors of parotid gland.