Carcinoma of salivary glands--a clinical analysis of 342 cases

342 cases with carcinoma of salivary glands were analysed. 152 tumors were located in parotid, 42 in submaxillary, 17 in sublingual and 131 in minor salivary glands. Pathological diagnosis were 106 mucoepidermoid carcinoma, 80 adenoid cystic carcinoma, 54 malignant mixed tumor, 40 adenocarcinoma, 38 papillary cystadenocarcinoma, 17 acinic cell carcinoma, 5 squamous cell carcinoma, and 2 undifferentiated carcinoma. The 3, 5, 10 and 15 year survival rates of these 342 cases were 76.6%, 65.9%, 48% and 29%, respectively. The difference between survival rate and relapse-free survival rate was about 8%. The prognosis of acinic cell carcinoma and mucoepidermoid carcinoma was much better than that of squamous cell carcinoma, adenocarcinoma and undifferentiated carcinoma. The survival rates, according to location, were: minor salivary gland tumors the highest, and those of submaxillary gland tumors the lowest. Postoperative radiotherapy improved the survival rate of adenoid cystic carcinoma. The overall recurrence rate was 37.4%, the neck lymph node metastasis rate 14.3% and the distant metastasis rate 9.1%.     

Malignant epithelial tumors in the minor salivary glands, the submandibular gland, and the sublingual gland. Prognostic factors and treatment results

Ninety-five malignant tumors in the submandibular gland, the sublingual gland, and the minor salivary glands seen in a 25-year period were reviewed. The patients were retrospectively staged using the Union Internationale Contre le Cancer (UICC) classification. The most frequent tumor was adenoid cystic carcinoma, followed by adenocarcinoma. The submandibular gland was the most frequent location. Five-year and 10-year crude survival rates were 62% and 43%, respectively. Clinical stage was the most important prognostic factor. Survival was not correlated with location of tumor, although recurrence and metastases occurred more frequently in patients with cancer of the submandibular gland. Histologically, the 5-year and 10-year survival was significantly better for patients with adenoid cystic carcinoma compared with the other types; however, although still significant, this difference diminished at 10 years, confirming the need for a long observation time for patients with this tumor.     

Salivary Gland Tumors in Turkey: Demographic Features and Histopathological Distribution of 510 Patients

The aim of this study was to evaluate the demographic and clinicopathologic data of salivary gland tumors managed at a tertiary referral medical center in Turkey. The data of 510 patients with salivary gland tumors managed during the period of January 1984 to May 2012, were reviewed. Only primary neoplasms derived from salivary glands were included. Out of 510 neoplasms, 352 (69.0 %) were classified as benign and 158 (31.0 %) were classified as malignant. There was a male predominance and male:female ratio was 1.23 (281/229). The most common location was parotid gland (372/510, 72.9 %) followed by minor salivary glands (97/510, 19.0 %) and submandibular gland (40/510, 7.9 %). The malignancy rates were 21.5, 40.0, and 56.7 % in parotid, submandibular, and minor salivary glands locations, respectively. The most common location for minor salivary gland neoplasms was oral cavity (61/97, 62.9 %). Pleomorphic adenoma (PA) was the most common histopathological type (45.3 %) in the whole study group and also among pediatric patients. The most common malignant neoplasms were adenoid cystic carcinoma (39/510, 7.6 %) and mucoepidermoid carcinoma (5.7 %). Salivary gland tumors are more common in men. The malignancy rate is almost three times higher in neoplasms derived from minor glands when compared to parotid gland. PA is the most common histopathological tumor type in all locations and in all age groups.     

Intraoral minor salivary gland tumors. Report of 296 cases (author's transl)

296 intraoral minor salivary gland tumors were observed among 702 salivary tumors. The study emphasizes a frequent palatine location, observed in more than 50 per cent of theses tumors. Pleiomorphic adenomas (or so called mixed tumors), are frequently encountered; but it is noteworthy that the proportion of muco-epidermoid tumors or adenoid cystic carcinoma is higher among theses tumors than among major salivary glands; this fact explain a poor overall prognosis of minor salivary gland tumors.     

Adenoid cystic carcinoma of the buccal vestibule: A case report and review of the literature

Minor salivary gland tumors of the buccal vestibule are relatively rare. Adenoid cystic carcinoma is the fifth most common salivary gland malignancy following mucoepidermoid carcinoma, adenocarcinoma not otherwise specified (NOS), acinic cell adenocarcinoma and polymorphous low-grade adenocarcinoma (PLGA). Greater than half of adenoid cystic carcinomas occur in the parotid and submandibular glands. The most common intraoral site is the palate. Adenoid cystic carcinoma tends to have a protracted clinical course with wide infiltration and late distant metastases. We present a case of an adenoid cystic carcinoma of the buccal vestibule in a 59-year-old Caucasian female patient that she had been aware of for 15 years.     

64例大涎腺腺样囊性癌的预后因素分析

背景与目的:涎腺腺样囊性癌是一类恶性程度高的涎腺肿瘤,针对大涎腺来源的腺样囊性癌的研究较少。本研究旨在探讨影响大涎腺腺样囊性癌患者预后的因素。方法:回顾性分析1971年1月至1998年7月中山大学肿瘤防治中心收治并随诊7年以上的64例大涎腺腺样囊性癌患者的临床资料,应用Kaplan-Meier法进行生存分析,组间比较用log-rank检验,多因素分析采用Cox模型进行分析,两组比率的比较采用χ2检验。结果:本组总死亡率为57.8%,肿瘤相关死亡率为46.9%;5年、10年累积生存率分别为65.6%和54.5%;复发率为34.4%,远处转移率为45.0%;单因素分析结果显示,年龄、神经是否受侵、病理类型、临床分期、手术切缘是否干净是影响患者预后的因素。年龄≥50岁、神经受侵、病理类型为实体型或小管型、临床分期为晚期(Ⅲ、Ⅳ期)、切缘阳性者的预后较年龄<50岁、神经未受侵、病理类型为筛孔状、临床分期为早期(Ⅰ、Ⅱ期)、切缘阴性者差;多因素分析结果显示,神经受侵、病理类型为实体型、临床分期属于晚期(Ⅲ、Ⅳ期)、切缘阳性者,预后差。结论:神经是否受侵、病理类型、临床分期、手术切缘是否干净是影响大涎腺腺样囊性癌患者预后的独立因素。     

Ezrin在涎腺腺样囊性癌组织中的表达

目的:探讨Ezrin在涎腺腺样囊性癌组织中的表达及意义。方法:用免疫组织化学SP法检测Ezrin在涎腺腺样囊性癌组织和正常涎腺组织中的表达,分析其在涎腺腺样囊性癌组织中的表达与肿瘤的侵袭性、复发、转移和预后的关系。结果:Ezrin在涎腺腺样囊性癌和正常涎腺组织中的阳性率表达分别为44.68%和9.09%,P<0.05;在癌细胞中主要为胞质内表达,染色深,而在正常涎腺组织则主要为细胞膜表达,染色浅或阴性。Ezrin的表达强度与有无神经受侵、有无发生局部复发及远处转移相关,P<0.05。Ezrin表达阳性组和阴性组的5年累积生存率分别为66.70%和100.00%,10年累及生存率分别为27.83%和95.00%,阳性组较阴性组预后差,P<0.05。结论:Ezrin的表达强度与涎腺腺样囊性癌的发生、侵袭性、复发和转移性有关,且Ezrin阳性表达预示患者预后不良。     

E钙粘素在涎腺腺样囊性癌中的表达及其意义

背景与目的:近年来关于上皮型钙粘素与肿瘤关系的研究比较多,但不同研究得到的结果差异较大,而且近年来的研究显示,E钙粘素在肿瘤转移过程中的作用可能具有多面性.本文旨在研究E钙粘素在涎腺腺样囊性癌中的表达水平,探讨E钙粘素与涎腺腺样囊性癌的神经侵犯、局部复发、远处转移以及预后的关系.方法:采用免疫组化技术检测55例涎腺腺样囊性癌组织标本和20例正常涎腺组织中E钙粘素的表达.应用Kaplan-Meier法进行生存分析,组间比较用log-rank检验,两组比率的比较采用χ2检验.结果:本组患者的5年和10年生存率分别为78.2%和51.4%:E钙粘素在正常涎腺组织中的阳性率(90.0%)显著高于涎腺腺样囊性癌组织(63.6%)(P＜0.05);E钙粘素在有神经受侵、局部复发及远处转移者的肿瘤组织中的阳性率(50.0%、52.4%及47.8%),均低于无神经受侵、无局部复发及无远处转移者(71.4%、70.6%及75.0%).结论:E钙粘素在涎腺腺样囊性癌组织中表达下调;其表达水平与神经侵犯、局部复发及发生远处转移相关.     

Lung,bone, skeletal muscles and cutaneous metastases from adenoid cystic carcinoma of the parotid gland: a case report and review of the literature

Adenoid cystic carcinoma is the second most common malignancy of the major and minor salivary glands after mucoepidemoid carcinoma. The risk of distant metastases is approximately 20–50%. Although bone, the central nervous system and the other organs may become involved, the lungs are favored sites for metastases. Skeletal muscle and cutaneous metastases from adenoid cystic carcinoma of the parotid gland are extremely rare. In this case, a 40-year-old man with lung and bone metastases followed by skeletal muscle and cutaneous metastases from adenoid cystic carcinoma of the right parotid gland is presented.     

126例涎腺腺样囊性癌的疗效及预后因素

目的　总结头颈部涎腺腺样囊性癌的治疗效果,评价影响局部复发和生存的因素。方法　回顾性分析126 例涎腺腺样囊性癌的临床资料。结果　总的局部复发率为35 % 。放射治疗有效率为80 % 。总的5,10 及20 年累积生存率分别为81.7% ,63 .8% 及37 .0% ;无局部复发者5,10 及20 年累积生存率分别为87 .6% ,77 .0% 及73 .1% ;总的5,10 及20 年局部控制率分别为85.7% ,60.1% 及29.4 % 。区域淋巴结转移率为10 % ,肺转移率为24 % 。分析结果表明:治疗方式、病理类型及外科切缘与局部复发有着明显的关系,病理类型、外科切缘及区域淋巴结转移对生存有明显的影响,而肿瘤部位和临床分期对局部复发和累积生存均无影响。结论　涎腺腺样囊性癌发展病程较慢,外科是主要的治疗方式,放射治疗可以有效地控制病变的发展,对局部病变较晚和外科切缘阳性的患者需手术加放射治疗的综合治疗     

Postoperative irradiation of minor salivary gland malignancies of the head and neck.

OBJECTIVES: (1) To review the Stanford experience with postoperative radiotherapy for minor salivary gland carcinomas of the head and neck. (2) To identify patterns of failure and prognostic factors for these tumors. MATERIALS AND METHODS: Fifty-four patients with localized tumors were treated with curative intent at Stanford University between 1966 and 1995. The 1992 AJCC staging for squamous cell carcinomas was used to retrospectively stage these patients. Thirteen percent had stage I, 22% stage II, 26% stage III, and 39% stage IV neoplasms. Thirty-two patients (59%) had adenoid cystic carcinoma, 15 (28%) had adenocarcinoma, and seven (13%) had mucoepidermoid carcinoma. Thirty (55%) had positive surgical margins and seven (13%) had cervical lymph node involvement at diagnosis. The median follow-up for alive patients was 7.8 years (range: 25 months-28.9 years). RESULTS: The 5- and 10-year actuarial local control rates were 91 and 88%, respectively. Advanced T-stage (T3-4), involved surgical margins, adenocarcinoma histology, and sinonasal and oropharyngeal primaries were associated with poorer local control. The 5- and 10-year actuarial freedom from distant metastasis were 86 and 81%, respectively. Advanced T-stage (T3-4), lymph node involvement at diagnosis, adenoid cystic and high-grade mucoepidermoid histology were associated with a higher risk of distant metastases. The 10-year cause-specific survival (CSS) and overall survival (OS) were 81 % and 63%, respectively. On multivariate analysis, prognostic factors affecting survival were T-stage (favoring T1-2), and N-stage (favoring NO). When T- and N-stage were combined to form the AJCC stage, the latter became the most significant factor for survival. The 10-year OS was 86% for stage I-II vs. 52% for stage III-IV tumors. Late treatment-related toxicity was low (3/54); most complications were mild and no cranial nerve damage was noted. CONCLUSIONS: Surgical resection and carefully planned post-operative radiation therapy for minor salivary gland tumors is well tolerated and effective with high local control rates. AJCC stage was the most significant predictor for survival and should be used for staging minor salivary gland carcinomas.     

The prognosis of specific types of salivary gland tumors

The relative rarity of salivary gland cancers means that there are few follow-up studies based on substantial numbers on which estimates of prognosis of the individual histologic subtypes can be based. In an attempt to overcome this problem 106 reports of follow-up studies were examined. For 52 studies a statistical method was devised to calculate 5-year and 10-year survival rates in uniform fashion. Fifty-four reports, however, had to be discarded either because of inadequacy of the data provided or because certain data essential for statistical analysis was lacking. Sufficient data was available for the estimation of survival rates for 2298 malignant salivary gland tumors of four histologic types. The overall 5-year and 10-year survival rates were found to be as follows: acinic cell carcinoma 82% and 68%, respectively; mucoepidermoid carcinoma 71% and 50%, respectively; adenoid cystic carcinoma 62% and 39%, respectively; malignant mixed tumor 56% and 31%, respectively. Since the great majority (over 70%) of salivary gland tumors are pleomorphic adenomas, and also since complete excision of these tumors presents considerable difficulties, their recurrence-free rate was also estimated and found to be 96.6% after 5 years and 93.2% after 10 years.     

Carcinomas arising in the submandibular gland: high propensity for systemic failure

BACKGROUND: Cancers of the submandibular gland are uncommon and only a few small series have reported patient survival and prognosis. METHODS: We examined the treatment outcomes of 62 patients with surgically treated submandibular gland carcinomas. All patients underwent surgical excision with/without neck dissection, and 41 received postoperative radiotherapy for high-grade, invasive, positive margin, or regionally metastatic tumors. The locoregional control and survival rates were calculated by the Kaplan-Meier method and prognostic factors were calculated from uni- and multivariate analyses. RESULTS: Of the 62 submandibular gland carcinomas, 19 were adenoid cystic, 11 were mucoepidermoid, and 10 were salivary duct carcinomas, and 8 were carcinomas in pleomorphic adenoma. Actuarial 5-year locoregional control, distant metastasis-free survival, disease-free and overall survival rates were 69.7%, 65.8%, 52.8%, and 56.8%, respectively. In multivariate analysis, T category and histological grading were prognostic for disease-free survival (P < 0.01), and T category and resection margins were prognostic for locoregional control (P < 0.02). Distant metastases were found in 21 patients (33.9%) at initial staging (n = 2) or follow-up (n = 19). CONCLUSIONS: Despite effective locoregional treatment, approximately one-third of patients with submandibular gland carcinomas may fail systemically, resulting in poor survival. New, more effective therapies may be required for these patients.     

Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy

PURPOSE: To examine the efficacy of fast neutron radiotherapy for the treatment of locally advanced and/or recurrent adenoid cystic carcinoma of the head and neck and to identify prognostic variables associated with local-regional control and survival. METHODS AND MATERIALS: One hundred fifty-nine patients with nonmetastatic, previously unirradiated, locally advanced, and/or recurrent adenoid cystic carcinoma (ACC) of the head and neck region were treated with fast neutron radiotherapy during the years 1985-1997. One hundred fifty-one patients had either unresectable disease, or gross residual disease (GRD) after an attempted surgical extirpation. Eight patients had microscopic residual disease and were analyzed separately. Sixty-two percent of patients had tumors arising in minor salivary glands, 29% in major salivary glands, and 9% in other sites such as the lacrimal glands, tracheal-bronchial tree, etc. Fifty-five percent of patients were treated for postsurgical recurrent disease and 13% of patients had lymph node involvement at the time of treatment. The median duration of follow-up was 32 months (range 3-142 months). Actuarial curves for survival, cause-specific survival, local-regional control, and the development of distant metastases are presented for times out to 11 years. RESULTS: The 5-year actuarial local-regional tumor control rate for the 151 patients with GRD was 57%; the 5-year actuarial overall survival rate was 72%; and the 5-year actuarial cause-specific survival rate was 77%. Variables associated with decreased local-regional control in the patients with GRD as determined by multivariate analysis included base of skull involvement (p < 0.01) and biopsy only versus an attempted surgical resection prior to treatment (p = 0.03). Patients without these negative factors had an actuarial local-regional control rate of 80% at 5 years. Patients with microscopic residual disease (n = 8) had a 5-year actuarial local-regional control rate of 100%. Base of skull involvement (p < 0.001), lymph node metastases at the time of treatment (p < 0.01), biopsy only prior to neutron radiotherapy (p = 0.03), and recurrent tumors (p = 0.04) were found to be associated with a diminished cause-specific survival as ascertained by multivariate analysis. Patients with base of skull involvement and positive lymph nodes at presentation had an increased rate of the development of distant metastases at 5 years, (p < 0.01 and p < 0.001, respectively). No statistical difference in outcome was observed between major and minor salivary gland sites. CONCLUSIONS: Fast neutron radiotherapy is an effective treatment for locally advanced ACC of the head and neck region with acceptable toxicity. Further improvements in local-regional control are not likely to impact survival until more effective systemic agents are developed to prevent and/or treat distant metastatic disease.     

Histogenesis of adenoid cystic carcinoma of the salivary glands. Light and electronmicroscopic study

This ultrastructural study, based on 12 cases of adenoid cystic carcinoma of the major and minor salivary glands, was conducted to determine the role and extent of participation of myoepithelial cells in their histogenesis. The tumors were composed of four major cell types; intercalated duct, myoepithelial, secretory, and pluripotential reserve/stem cells. The cellular composition of adenoid cystic carcinoma is similar to that in the "terminal tubule" complex stage of a developing salivary gland except that in the tumor the pluripotential reserve/stem cells differentiate predominantly along the intercalated duct cell line rather than secretory cells as in the acinic cell carcinoma. Furthermore, adenoid cystic carcinoma appears to contain a far greater number of myoepithelial cells than acinic cell carcinomas.     

Carcinoma of the parotid and submandibular glands--a study of survival in 2465 patients

Salivary gland carcinomas demonstrate a wide diversity of histopathological types and biological behavior. The aim of this study was to analyze relative survival of patients with major salivary gland carcinomas with special reference to histopathology, gender and age. All new carcinomas of the major salivary glands reported to the National Swedish Cancer Registry 1960-1995 were searched for and the vital status of the cases was updated by record linkage to the Swedish Population Registry through December 31 1996. The study comprised 2465 patients with carcinoma of the parotid or submandibular glands. Relative survival differed markedly according to histopathological typing (P<0.001). For parotid tumors, acinic cell carcinomas had the best prognosis with a 10-year relative survival of 88%. The corresponding figures for mucoepidermoid carcinomas, adenoidcystic carcinomas and carcinoma ex pleomorphic adenoma were 80, 74 and 73%. Adenocarcinoma NOS and undifferentiated carcinoma had worse prognosis, with 10-year relative survival of 55 and 44%. Patients with submandibular gland cancer had similar relative survival to those with parotid cancers, besides those with mucoepidermoid cancer and adenocarcinoma NOS, who carried worse prognosis. Age and gender had an impact on relative survival for patients with mucoepidermoid carcinoma, adenocarcinoma and undifferentiated cancer of the parotid.     

抑癌基因P16在涎腺腺样囊性癌中的表达意义

目的：探讨抑癌基因P16与涎腺腺样囊性癌的发生发展的关系。方法：采用免疫组织化学法检测30例腺样囊性癌中P16基因表达情况。结果：腺样囊性癌组织中阳性表达率为76．6％,P16蛋白阳性率在腺样囊性癌的腺样型,管状型,混合型,实体型中分别为90％,100％,42．9％,显示P16蛋白表达阳性率随恶性程度的上升而,降低,P16阳性与阴性之间的5年生存率则无明显差异。结论：抑癌基因P16的表达与肿瘤的病理类型有关,而腺样囊性癌预后好于其它肿瘤可能与P16缺失少有关。     

腮腺腺样囊性癌的治疗进展

腺样囊性癌是最常见的腮腺恶性肿瘤之一.腮腺腺样囊性癌(parotid gland adenoid cystic carcinoma)具有嗜神经侵袭和远处转移的特点,局部控制率和长期生存率不佳.现结合文献,对目前腮腺腺样囊性癌的治疗现状及进展做一综述.     

Recurrent malignant salivary gland neoplasms

Recurrent salivary gland malignancies present difficult therapeutic decisions and poor prognosis in many instances, and treatment becomes of a palliative nature only. As many of the salivary gland malignancies we see are of the recurrent type, the following study was done to determine the efficacy of a vigorous attempt at retreatment. During the period January 1, 1960, through December 31, 1984, 352 patients with major and minor salivary gland tumors were evaluated at our institution. There were 149 benign lesions and 203 patients with malignant tumors. Of these, 99 patients had recurrent and metastatic tumors that had been treated initially elsewhere. Thirty-three of these patients were able to be treated with curative intent: surgery, 21; surgery plus radiation, 9; radiation therapy alone, 2; and radiation plus chemotherapy, 1. The 5 year survival with no evidence of disease was achieved in three patients with surgery alone and two patients with surgery plus radiation therapy. The group of five patients was comprised of two patients with adenoid cystic carcinomas of the parotid, one with intermediate grade mucoepidermoid carcinoma of the parotid, one, sebaceous cell carcinoma of the parotid, and one, adenoid cystic carcinoma of an accessory salivary gland. The results of this study serve to re-emphasize the relative poor yield of attempts at retreatment of loco-regional recurrence of salivary gland tumors.     

24例涎腺恶性多形性腺瘤的临床分析

目的 了解涎腺恶性多形性腺瘤的临床特征、治疗和预后。方法 24例经病理证实的涎腺恶性多形性腺瘤,对其诊断、治疗以及生存率进行分析。结果 恶性多形性腺瘤患者总的5年生存率为66．7％,其中发生于大涎腺者5年生存率为63．6％,发生于小涎腺2例均存活5年以上。结论 治疗首选手术,提倡首治行规范切除,位于领下腺者建议行预防性颈清扫;术后补充放疗不提高局部控制率。