涎腺淋巴上皮癌的治疗现状研究进展

涎腺淋巴上皮癌是一种伴有淋巴间质浸润的未分化癌,发病率低,其发病与EB病毒感染、免疫反应、良性淋巴上皮病变等因素有关。近年来研究证实,涎腺淋巴上皮癌是一种放射治疗敏感肿瘤,手术联合术后放射治疗为本病治疗的常用模式,获得了良好的局部控制率及无病生存率。     

涎腺恶性肿瘤174例疗效观察

目的 分析影响涎腺恶性肿瘤治疗疗效的因素.方法 本文回顾总结收治的涎腺恶性肿瘤174例患者的临床资料,患者先行接受手术治疗,术后大部分患者加用60Co、X线外照射28 ～76 Gy.结果 全组总的5a生存率为66.3％,10 a生存率为57.5％,15 a生存率为46.4％,20 a生存率为11.2％.术后放疗、手术完全切除、病变在腮腺和早期患者的预后较好,其5 a生存率高于单纯手术、肿瘤残留、病变在其他涎腺和晚期患者,差异均有统计学意义(P均＜0.05).结论 涎腺恶性肿瘤以手术加放疗为宜,疗效与手术是否完全切除、病变部位及分期有关.     

改良CHOP方案治疗涎腺淋巴上皮癌1例报告

0 引言 涎腺淋巴上皮癌(lymphoepithelial carcinoma of salivary gland)是一种发生在涎腺的、以淋巴组织增生、浸润并包含低分化或未分化癌组织为特征的恶性肿瘤.占涎腺肿瘤的比例不超过1％[1].该肿瘤多发于颌面部腺体,尤以腮腺发病率最高[2].相对于其他唾腺未分化癌,该病的治疗预后较好,生存时间较长,5年生存率的报道从22.2％～70.66％不等[3-5].主要死亡原因为远处转移和肿瘤复发.在国内外文献中,该病是以手术治疗为主体的综合治疗[5-6],手术及放疗的应用多,化疗的应用非常少.甚至有人认为目前没有有效药物治疗该病[7].我科单纯应用化疗有效地缓解了1例患者的症状,延长了生存时间,现报道如下.     

54例大涎腺腺样囊性癌的治疗疗效和预后分析

目的 腺样囊性癌(ACC)是头颈部少见的恶性肿瘤,本研究分析大涎腺ACC的治疗疗效和预后因素.方法 回顾分析54例大涎腺ACC患者,其中腮腺24例,颌下腺或舌下腺30例.单纯手术治疗26例,术后放疗28例.放疗中位剂量为58 Gy(50～65 Gy).结果 随访率为94%,其中随访时间满5年者35例,术后放疗组和单纯手术组分别为15例和20例.全组5年总生存率为97%,5年局部区域控制率为71%,5年远处转移率为13%(7例均为肺转移),5年无瘤生存率为69%.局部区域失败15例,其中单纯手术组13例,术后放疗组2例.术后放疗组和单纯手术组5年局部区域控制率分别为90%和54%,无瘤生存率分别为85%和55%.单因素和多因素分析均显示术后放疗是影响局部区域控制和无瘤生存率的一个重要预后因素.结论 大涎腺ACC术后放疗与单纯手术相比明显提高了疗效,但远处转移较常见.     

54例原发鼻咽涎腺型癌的临床分析

目的 分析原发鼻咽涎腺型癌临床特点、治疗方法及预后因素。方法 回顾分析1963—2006年本院收治的 54例原发鼻咽涎腺型癌患者资料,其中腺样囊性癌 36例、黏液表皮样癌 11例、腺癌 7例,单纯手术 2例、单纯放疗 30例、综合治疗 22例(手术加放疗 15例,放疗加手术 7例)。8例接受化疗(术后辅助化疗 1例,同期放化疗 1例,复发后化疗 6例)。用Logrank法单因素分析。结果 随访率为89%。2、5年总生存率分别为85%、61%,无局部区域失败生存率分别为74%、55%,无远处转移生存率分别为92%、70%。治疗失败 35例,其中 26例局部区域失败(1例鼻咽复发加颈部淋巴结转移,23例鼻咽复发,2例颈部淋巴结转移)。发生远处转移 13例(4例出现多脏器转移),其中肺转移 10例、肝转移 3例、骨转移 2例、脑转移 1例、皮下转移 1例。单因素分析显示病理亚型与总生存率相关(χ²=15.29,P=0.000),而颈部淋巴结转移与无远转生存率相关(χ²=9.08,P=0.003)。结论 鼻咽涎腺型癌是一种局部侵袭性强、病程发展相对较慢的疾病,治疗上推荐手术与放疗的综合治疗。     

涎腺淋巴上皮病及癌变的放射治疗

1974～1989年收治12例涎腺淋巴上皮病患者,其中6例恶性采用术后放疗Dr30～50Gy/3～6W,疗后4例至今已生存3、5～15年。6例良性患者中3例用药物治疗,3例放疗Dr19.5～28.5Gy/3～5W.疗后8个月～12年无复发。本组有一例为2次手术后病理证实的良性涎腺淋巴上皮病发生恶变。对恶性病变,采用肿瘤广泛切除,并给予术后放疗有助于改善治疗结果。对良性患者一般治疗无效时,可采用放疗效果良好。     

原发于涎腺的非霍奇金淋巴瘤临床分析

目的探讨原发于涎腺非霍奇金淋巴瘤（NHL）的临床、病理特点,治疗方法和预后。方法18例原发于涎腺的非霍奇金淋巴瘤经术后病理证实。术后放射治疗15例,单纯放疗10例,放疗加化疗5例,单纯化疗2例,未治疗1例。放射治疗剂量为40-55Gy（1．8—2．0Gy／次,5次／周）,化疗采用CHOP方案1—4周期。结果5年生存率76．0％,10年生存率60．2％,2例患者死于远处转移。结论涎腺NHL以低度恶性淋巴瘤多见,术后放射治疗为主的局部治疗有较好效果。早、中期患者宜采用放射治疗,晚期患者以放疗加化疗为宜。     

小涎腺肿瘤60例临床分析

目的　探讨小涎腺肿瘤的发病情况 ,临床特点及诊断治疗。方法　对 1 980～ 1 995年间收治的经病理确诊的 60例小涎腺肿瘤的年龄、性别、好发部位、诊断、治疗等进行了回顾性综合分析。结果　 60例口腔小涎腺肿瘤 ,良性肿瘤 2 6例占 43 .33 % ,恶性肿瘤 34例占 56 .67% ,良性肿瘤中的混合瘤多见占良性肿瘤的 69.2 3 % ,恶性肿瘤中以黏液表皮样癌为多 ,1 4例占恶性肿瘤的 41 .1 8% ,手术 +放疗者占恶性肿瘤的 38.2 4 % ,5年生存率为 68.97%。结论　小涎腺肿瘤中恶性肿瘤多于良性肿瘤。术前X线检查和术中冰冻病理检查对诊断和治疗方案有指导意义。首次手术彻底性是防止复发的关键。术后辅助放疗可降低恶性肿瘤复发率     

涎腺腺样囊性癌的综合治疗（附54例临床分析）

本文总结自1969年至1992年收治的54例涎腺腺样囊性癌患者的治疗经验。着重讨论对这种生长缓慢，具有局部侵润性，易于复发和转移的中等度恶性肿瘤的手术及术后放化疗结果，这种肿瘤应急取早期行局部大块彻底切除，保持足够的手术安全边缘是防止局部复发和提高生存率的重要因素。由于该肿瘤易于复发和转移，且病人可带瘤生存若干年，故应尽量争取手术，该肿瘤对放射线及化学药物均显示一定程度的敏感性，故主张术后配合放疗及化疗效果更好。54例病人，其5年生存率为70.4%(38/54)；10年生存率为44.4%(24.54);15年生存率为18.5%(10/54)。     

涎腺淋巴上皮癌临床病理观察

目的:探讨涎腺淋巴上皮癌的临床病理学特征和鉴别诊断.方法: 对5例涎腺淋巴上皮癌的临床特征、组织学形态和免疫学表型进行观察.结果: 3例肿瘤发生于耳垂下,2例发生于下颌下区.临床主要表现为局部包块,活动度差,伴有疼痛.组织学特点为肿瘤细胞较大,多角形、卵圆形,细胞核泡状,肿瘤细胞呈片状、岛状、索条状,间质为成熟的淋巴细胞和浆细胞.免疫组化:5例肿瘤细胞CK(pan)、EMA、EBV均为(+);而S-100、CgA、CD68、LCA、Vimentin、SMA均为(-);间质细胞CD3、CD20、CD43均为部分 (+). 结论: 涎腺淋巴上皮癌非常少见,是一种分化差,但是预后尚可的肿瘤,确诊依赖组织学和免疫组化检测.手术广泛全切和术后辅助放疗是本病的最佳治疗措施.     

鼻咽部小涎腺肿癌

Minor salivary gland tumors of the nasopharynx are rare. Among them, adenoid cystic carcinoma was most frequently seen. In this paper, 16 cases of minor salivary gland tumor of the nasopharynx admitted to our hospital during the past 27 years are reported. Patients' age ranged from 23 to 74 years with an average of 38.2 years in the women and 45.6 years in the men. Patients with malignant tumor often complained of headache, epistaxis, hearing and sight loss etc. Nasopharyngeal masses were found in all In some cases, paralysis of one or more cranial nerves was demonstrated by neurological examination and destruction of the base of skull by X-ray tomography. Of 16 cases, only 1 had benign mixed tumor and the rest suffered from malignant diseases (2 malignant mixed tumors and 13 adenocarcinomas). Radiotherapy was the main treatment. Some patients received surgical resection plus radiotherapy. 75% of the patients survived over 5 years.     

Phase II randomized trial comparing vinorelbine versus vinorelbine plus cisplatin in patients with recurrent salivary gland malignancies

BACKGROUND: Some previous studies have shown that vinorelbine (VNB) is active in recurrent salivary gland tumors. METHODS: Between April 1993 and April 1997, 36 patients in a Phase II randomized trial received either cisplatin, 80 mg/m(2), on Day 1 plus VNB, 25 mg/m(2), on Days 1 and 8 (every 3 weeks) (for a minimum of 3 cycles (Arm A [16 patients]), or VNB, 30 mg/m(2)/week, (for a minimum of 9 wks) (Arm B [20 patients]). There were 23 males and 13 females with a median age of 59 years (range, 20-74 years) and a median Eastern Cooperative Oncology Group performance status of 1 (range, 0-2). Four patients had been treated with prior surgery (S) or radiotherapy (RT), 27 patients had been treated with S plus RT, and 5 patients had been treated with S plus RT plus mitoxantrone. Eighteen patients had major salivary gland tumors, and 18 patients had minor salivary gland tumors; 9 patients had adenocarcinoma, 22 patients had adenoid cystic carcinoma, 1 patient had a malignant mixed carcinoma, 3 patients had undifferentiated carcinoma, and 1 patient had a mucoepidermoid carcinoma. The site of recurrence was local in 16 patients, local plus metastatic in 5 patients, and metastatic only in 15 patients. These characteristics were well balanced between the 2 arms. RESULTS: In Arms A and B a complete response (CR) was noted in 3 patients (19%) and no patients, respectively; a partial response (PR) was noted in 4 patients (25%) and 4 patients (20%), respectively; no change was noted in 6 patients (37.5%) and 9 patients (45%), respectively; and progressive disease was noted in 3 patients (19%) and 7 patients (35%), respectively. The median duration of the CR was 15+ months (range, 6-27+ months) and for PR the median duration was 7.5 months (range, 3-11+ months) and 6 months (range, 3-9 months) in Arms A and B, respectively. Number of patients surviving > 12 months was 6 versus 1 in Arms A and B, respectively (P < 0.05). Grade 2-3 nausea and emesis was statistically higher (P < 0.001) in Arm A; there was no significant difference with regard to other side-effects between the two treatment arms. CONCLUSIONS: VNB is a drug with moderate activity in salivary gland malignancies. The combination of cisplatin plus VNB was found to be more active than VNB alone, with a good number of CRs and long-term survivors reported in the current study.     

Lymphoepithelial carcinoma versus large cell undifferentiated carcinoma of the major salivary glands

BACKGROUND: Undifferentiated carcinomas of the major salivary glands are rare malignant neoplasms of the head and neck region, and patients with these lesions have a poor prognosis. Patients with lymphoepithelial carcinoma (LEC), a specific subtype of undifferentiated carcinoma, however, have a better prognosis, and LEC seems to differ from large cell undifferentiated carcinoma (LCUC) clinically. METHODS: Sixteen patients with LEC and 12 patients with LCUC were retrieved from the records of 295 patients who had malignancies of the major salivary glands. A retrospective study on clinical manifestations, treatments, long-term outcomes, and an association with Epstein-Barr virus (EBV) by EBV-encoded small RNA-1 in situ hybridization was conducted to identify their differences. RESULTS: The median patient age was 44.5 years in the LEC group and 56 years in the LCUC group. At the time of presentation, patients with LCUC had a history of rapid-growing tumor and more advanced locoregional disease (Stage IV in 75% of patients with LCUC compared with 13% of patients with LEC). All 16 patients with LEC underwent curative surgery and radiotherapy, and their 5-year survival rate was 85.6%. In the LCUC group, only 7 patients were eligible to undergo radical surgery and receive radiotherapy, and their 2-year survival rate was only 36%. Age > 50 years was associated with a significantly worse prognosis for patients with LCUC. Neck metastasis and tumor size > 6 cm tended to be poor prognostic factors. Tumors were positive for harboring the EBV genome in all 16 LEC samples but in none of the LCUC samples. CONCLUSIONS: The clinicopathologic features of LEC and LCUC of the major salivary glands were different. LEC was associated with EBV, and patients with LEC had a much better prognosis compared with the prognosis for patients with LCUC. Therefore, LEC should be put in an independent group and should not be included in the same category as undifferentiated carcinomas of the salivary gland.     

涎腺淋巴上皮癌临床病理观察

目的：探讨涎腺淋巴上皮癌的临床病理学特征和鉴别诊断。方法：对5例涎腺淋巴上皮癌的临床特征、组织学形态和免疫学表型进行观察。结果：3例肿瘤发生于耳垂下,2例发生于下颌下区。临床主要表现为局部包块,活动度差,伴有疼痛。组织学特点为肿瘤细胞较大,多角形、卵圆形,细胞核泡状,肿瘤细胞呈片状、岛状、索条状,间质为成熟的淋巴细胞和浆细胞。免疫组化：5例肿瘤细胞CK（pan）、EMA、EBV均为（＋）;而S-100、CgA、CD68、LCA、Vimentin、SMA均为（-）;间质细胞CD3、CD20、CD43均为部分（＋）。结论：涎腺淋巴上皮癌非常少见,是一种分化差,但是预后尚可的肿瘤,确诊依赖组织学和免疫组化检测。手术广泛全切和术后辅助放疗是本病的最佳治疗措施。     

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.     

原发腮腺淋巴上皮癌临床特征与诊断及疗效分析

目的 分析原发腮腺淋巴上皮癌的临床特征、诊断特点及预后。方法 回顾性分析2009-2017年经中国医学科学院肿瘤医院确诊的13例腮腺淋巴上皮癌患者临床资料,中位随访时间38.5个月,所有患者均先行手术+放疗。结果 全组13例患者中男9例,女4例,中位年龄33岁。确诊时局限于腮腺9例、区域淋巴结转移4例,均为Ⅰ b、Ⅱ区。UICC2010分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为1、1、6、5例。11例患者手术病理标本EBER检测10例阳性。全组无死亡事件,3年总生存率100%,3年无进展生存率76%,3年局部控制率92%,3年无远处转移率84%。结论 腮腺淋巴上皮癌发病率较低,病变与EBV相关,容易发生颈部淋巴结转移,疗前应除外鼻咽癌转移至腮腺的可能。目前治疗模式是以手术+放疗,总体预后较好,治疗失败主要原因为局部复发和远处转移。     

Outcome of Surgery and Post-Operative Radiotherapy for Major Salivary Gland Carcinoma: Ten Year Experience from a Single Institute

Aims: To determine the clinical characteristics, pathological features, local and distant failure patterns inpatients with carcinoma of major salivary glands treated with surgery and postoperative radiotherapy (PORT).Materials and Methods: We retrospectively reviewed 106 cases of major salivary gland tumor seen at our centre(1998-2008). Sixty five cases of major salivary gland carcinoma were selected for analysis (exclusions: benign,palliative, non-carcinomas). The patient population treated by surgery and PORT was divided into two groups:1) Patients who underwent surgery and immediate PORT (Primary PORT); 2) Patients with recurrent carcinomawho underwent at least two surgeries and received PORT in the immediate post-operative period of the lastperformed surgery (Recurrent PORT). Recurrence free survival (RFS) was assessed using the Kaplan-Meiermethod. Results: Median age was 35 years with a male: female ratio of 1.3:1. The majority of cancers were locatedin the parotid gland (86.2%) and the most common histology was mucoepidermoid carcinoma (43%). Thirtynine cases (60%) were primary while 26 (40%) were recurrent. Optimal surgery was performed in 59/65 patients(90.8%). 43 patients (66.2%) underwent neck dissection, of which 14 (32.5%) had nodal metastasis. Overall, 61(93.8%) patients complied with the prescribed radiotherapy. Median dose of PORT was 60 Gy. Median follow-upwas 13.1 months (range 2-70). Relapse free survival was 50.4% at 60 months. Some 12 cases (18.5%) recurredwith a median time to recurrence of 16.9 months. Conclusions: Surgery and PORT is an effective treatmentfor major salivary gland carcinoma with over 90% compliance and <20% recurrence. Early treatment withpostoperative radiotherapy may increase the survival rate in major salivary gland carcinoma patients.     

Ultrastructural investigation of anaplastic salivary gland carcinomas in Eskimos

Ultrastructural investigation of 19 malignant lymphoepithelial salivary gland tumors in Greenland Eskimos disclosed evidence of epithelial origin of the tumor cells in 18 cases. Furthermore, tumor cells exhibited markers of squamous cell differentiation in 16 cases. Signs of adenomatous differentiation were never encountered. Thus, the malignant lymphoepithelial tumor of salivary glands is the ultrastructural counterpart to the nasopharyngeal anaplastic carcinoma (malignant lymphoepithelioma), both being high-grade squamous cell carcinomas.     

Mucoepidermoid carcinoma of salivary glands in children and adolescents: assessment of proliferation markers

Malignant neoplasms represent one-third of all pediatric salivary gland tumors. Mucoepidermoid carcinoma (MEC) composes 51% of malignant tumors and 16% of all salivary gland neoplasms in pediatrics. Prognostic factors in MEC in pediatric patients have not been well defined. Histopathologic features, clinical outcomes and proliferation markers in 26 pediatric patients (median age 11 years; 19F:7M) with salivary gland MECs were evaluated retrospectively. MEC histocytologic grading used a three-tiered system. Proliferation was assessed by determining the percentage of tumor cells immunoreactive for PCNA and Ki-67. Tumor site was 16 parotid, eight submandibular, one base of tongue and one maxillary lip. Median tumor size was 2.5 cm (range 1.5-5 cm). MEC grade was nine low grade (LG), 15 intermediate grade (IG) and two high grade (HG). Metastatic disease and capsular invasion occurred in five cases, while perineural invasion was noted in three cases. Mean percentage of tumor cells immunoreactive for proliferation markers is as follows: PCNA: LG 9%, IG 17%, HG 32%; and Ki-67: LG 7%, IG 12%, HG 26%. Treatment was surgical in 21 cases, and surgery with chemotherapy and radiotherapy in five cases. Two patients with high grade MECs died of disease (21, 44 months). Twenty-four patients had no evidence of disease at a median follow-up of 104 months (range 30-298 months). MECs were second malignancies in two children with prior radiotherapy and chemotherapy for leukemia and histiocytosis. Low and intermediate grade salivary gland MECS in a pediatric population may have a favorable outcome when compared with high grade MECs. Proliferation markers appear to be linked to histocytologic MEC grade and may provide information regarding biologic behavior of salivary gland MECs in children and adolescents.