Combined treatment of adenoid cystic carcinoma of the salivary glands

A retrospective review of the experience of a single surgeon over a 20-year period is presented. Fifteen patients with primary adenoid cystic carcinoma of the major (6) or minor (9) salivary glands underwent combined treatment with wide local excision and radical postoperative radiotherapy. The actuarial survival is 100% at 5 years and 62% at 10 and 15 years. The disease-specific survival is 100% at 5 years and 86% at 10 and 15 years. There were no loco-regional recurrences. Wide local excision and radical postoperative radiotherapy seems to be an effective treatment for adenoid cystic carcinoma of the salivary glands.     

Factors influencing survival of patients with adenoid cystic carcinoma of the salivary glands

The uncertain long-term cure of adenoid cystic carcinoma of the salivary glands was determined in 30 treated patients seen between 1952 to 1984. Ten of 25 patients received elective postoperative irradiation (SEPI) after surgical extirpation of the primary/recurrent lesion; five patients had definitive radiotherapy alone. Overall, survival rates were 60%, 30%, and 7% at five, 10, and 20 years, respectively. The incidence of local recurrence was 37%, regional recurrence 3%, and distant metastasis 37%. Fewer recurrences and distant metastases were in the SEPI group than the surgery alone group. The majority of failures occurred within 10 years after initial diagnosis of primary malignancy; most of the patients died within five years after failure(s) detection. Correlations of prognosis to site of origin, and local control to total radiotherapy dose were observed. It is concluded that cure of disease can be achieved with the use of appropriate therapy.     

涎腺腺样囊性癌的治疗进展

腺样囊性癌多发生于涎腺,是常见的恶性肿瘤.目前,治疗涎腺腺样囊性癌主要是采用以手术为主,辅以术后放射治疗的综合治疗方案,但是该治疗方案对肿瘤局部复发和远处转移的控制效果尚不理想.本文主要从化学治疗、放射治疗和基因分子治疗等方面介绍涎腺腺样囊性癌治疗的新进展,希望能为临床治疗提供一些有效的信息,进一步完善相关的治疗.     

150例涎腺癌的临床分析

分析150例涎腺癌,发生在腮腺61例,颌下腺14例,舌下腺5例,和小唾腺70例。病理分型:癌在多形性腺瘤中49例,腺癌25例,腺样囊性癌24例,粘液表皮样癌22例,腺泡细胞癌22例,鳞状细胞癌5例,乳头样囊腺癌2例,未分化癌1例。150例涎腺癌3、5、10年生存率为80.7％、69.4％、52.1％。腺泡细胞癌和粘液表皮样癌预后较鳞状细胞癌、腺癌和未分化癌好。生存率根据部位,小唾液腺和腮腺肿瘤最高,舌下腺和颌下腺最低。术后放疗和化疗,对涎腺癌,生存率是重要的,涎腺癌复发率为27.6％,颈淋巴结转移率为9.2％。     

30例舌下腺恶性肿瘤临床病理分析

目的探讨舌下腺恶性肿瘤的临床病理特征及治疗方法。方法对1955-2005年四川大学华西口腔医院颌面外科收治的30例舌下腺恶性肿瘤患者进行回顾性分析。结果30例舌下腺恶性肿瘤患者中,男性18例,女性12例;平均年龄50.6岁。腺样囊性癌为舌下腺恶性肿瘤最常见的病理类型（56.7%）;临床分期中Ⅲ期最常见（56.7%）,局部复发和远处转移是患者死亡的主要原因,局部复发率为30.0%,远处转移率为26.7%。结论舌下腺恶性肿瘤以腺样囊性癌为主。手术是主要的治疗方法,原发灶切除配合颈部淋巴清扫术是达到良好治疗效果的关键,术后应适当辅助放化疗。     

涎腺腺样囊性癌的局部复发及远处转移因素分析

目的:探讨影响涎腺腺样囊性癌患者术后局部复发及远处转移相关因素。方法:回顾性分析49例涎腺腺样囊性癌患者的年龄、性别、民族、病变部位、治疗方法、临床分期、病理分型、病理分级、神经及周围组织侵犯、手术切缘等临床资料,通过随访后采用单因素分析,其中有统计学意义的因素再进入分析模型进行多因素的logistics回归分析;探讨各临床病理因素与患者术后复发及远处转移的关系。结果:总复发率为46.9%,远处转移率为30.6%;单因素分析结果显示:病理分型、病理分级、周围组织侵犯、手术切缘是否干净是影响患者术后复发或转移的因素。多因素分析结果显示:年龄、病变部位、病理分型、周围组织侵犯是影响术后复发,手术切缘是影响术后转移的独立因素。结论:病理分型、手术切缘是术后局部复发或转移的独立相关因素,因此对有高危险复发或转移因素的患者尽量做到手术切缘干净并定期追踪随访。     

Analysis of the clinicopathological characteristics and prognosis of adenoid cystic carcinoma of the intraoral minor salivary glands: a retrospective study of 40 cases

The clinicopathological aspects and prognostic factors of 40 patients with adenoid cystic carcinoma (ACC) of the intraoral minor salivary glands, treated between 2007 and 2017 at a single institution, were evaluated retrospectively. Twenty-six were female and 14 were male, and they ranged in age from 26 to 81 years (median 55 years). ACC occurred mainly in the palate, with 54.8% of cases presenting T3–T4 lesions. Curative surgery was performed in all patients, and 62.5% of patients were treated with postoperative adjuvant radiotherapy. In the final analysis, positive surgical margins were noted in 57.5% of cases and perineural invasion in 70%. Follow-up was at least 13 months (range 13–141 months, median 59 months). Nineteen patients (47.5%) developed recurrent disease after initial surgery and nine patients had died at the end of follow-up. The 5- and 10-year overall survival rates were 88.3% and 25.6%, respectively. The 5- and 10-year disease-free survival rates were 75.6% and 34.0%, respectively. Patients with a tumour size >4 cm and those with positive surgical margins showed a significantly higher risk of local recurrence. Elective neck dissection is suggested for patients with clinically positive lymph nodes or a locally advanced tumour, especially those undergoing microvascular reconstruction. The survival analysis results are similar to those reported previously in the literature.     

涎腺腺样囊性癌嗜神经侵袭分子机制的研究进展

涎腺腺样囊性癌是发生于涎腺的一种非常常见的恶性肿瘤,其重要特质是嗜神经侵袭,这一特质是其在临床手术中很难被彻底切除的重要原因之一;部分肿瘤细胞的残留易导致肿瘤术后复发,成为临床治疗的一大难题。因此,深入探讨涎腺腺样囊性癌嗜神经侵袭这一特性的分子机制对克服这一难题具有重要意义,本文就涎腺腺样囊性癌嗜神经侵袭分子机制的研究进展作一综述。     

Analysis of adenoid cystic carcinoma treated by radiotherapy.

The records of 41 patients with adenoid cystic carcinoma of the head and neck region who had been treated with radiotherapy were reviewed. Local control was achieved in 72.3% in the cases with primary lesions at 5 years. The prognosis for tumors that arose in the major salivary glands was better than that for tumors that arose in the minor salivary glands; however, the difference was not statistically significant. In the minor salivary glands, early-stage tumors were well controlled with the use of radiation therapy alone. In spite of the high local control rate, the disease-free survival rate of the patients at 10 years was only 20.8%. Lung metastasis determined the prognosis.     

影响唾液腺粘液表皮样癌患者术后生存的临床病理因素分析

目的　探讨影响唾液腺粘液表皮样癌患者术后生存的临床病理因素。方法　回顾经首次手术治疗且有完整随访资料的唾液腺粘液表皮样癌患者 70例的临床资料 ,对各项指标采用乘积限法 (Kaplan-Meier)估计各时点的生存率 ,同时进行序检验 (Logranktest)各组间差异 ,最后进入Cox比例风险模型 (CoxRegression)做多因素分析。全部资料通过SPSS软件完成。结果　 70例唾液腺粘液表皮样癌患者 ,术后 3、5、1 0年生存率分别为 90 6 6 %、88 85 %、86 6 3%。肿瘤直径小于等于 4cm、术前区域淋巴结无转移、临床处于早期 (Ⅰ、Ⅱ期 )、高分化、术后无复发和转移的患者生存期明显长于肿瘤直径大于 4cm、术前区域淋巴结有转移、临床晚期 (Ⅲ、Ⅳ期 )、低分化、术后出现复发及转移的患者。结论　TNM分类、临床分期、分化程度以及术后有无复发和转移是影响唾液腺粘液表皮样癌患者术后生存的重要因素.     

微血管密度和血管内皮生长因子在涎腺腺样囊性癌中的表达

目的研究微血管密度(microvesseldensity,MVD)和血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)在涎腺腺样囊性癌中的表达,探讨其与该肿瘤的临床病理关系。方法采用SP免疫组织化学染色方法检测55例涎腺腺样囊性癌中MVD和VEGF的表达,采用SPSS软件行统计分析。结果VEGF在小涎腺腺样囊性癌中的高表达阳性（强度）率明显高于大涎腺(P=0.0398);随着肿瘤分期的增加,VEGF的高表达率明显增加(P=0.0175);而MVD与肿瘤部位、分期差异无显著性。MVD和VEGF的表达与该肿瘤的局部复发、远处转移、区域淋巴结转移、组织类型及生存率无显著的相关性。VEGF高表达组的平均MVD值明显高于低表达组的平均MVD值(P=0.0202)。结论在涎腺腺样囊性癌中,MVD和VEGF作为预后因素需要进一步的研究分析,二者的表达呈明显的正相关。     

57例涎腺腺样囊性癌的临床研究

腺样囊性癌（ＡＣＣ）约占涎腺肿瘤的１０～１５％。本文报告５７例中，男性３３例，女性２４例，年龄在１８～７１岁之间，以３５～５５岁多见。发病部位以腭部多见，其次为颌下腺、舌下腺。随访时间１～２０年，影响ＡＣＣ最终治愈的原因是局部复发和远处转移，局部复发以颌下腺（８２％）、舌下腺（７１％）多见，复发时间在术后１～１０年，远处转移主要是肺脏（６０％），颈淋巴结转移率为１０％，远处转移多发生在术后５～１０年，由于其远期局部复发及远处器官转移，以及带瘤生存期较长，作者认为使用五年生存率，判断治疗成功与否，随访时间似嫌过短，应对ＡＣＣ至少作１０年以上的随访，随访时应特别注意肺转移。对ＡＣＣ的治疗，除进行根治性手术外，术后应辅助放疗。     

63例涎腺腺样囊性癌患者预后相关因素的Cox模型分析

目的 探讨影响涎腺腺样囊性癌(adenoid cystic carcinoma,ACC)患者术后生存的相关因素。方法 回顾性分析1988年1月—2005年10月在我院手术治疗并经病理确诊的63例涎腺ACC患者临床资料,对可能影响患者术后生存的指标进行Kaplan-Meier检验后,采用Cox比例风险回归模型进行多因素分析。结果 63例涎腺ACC患者术后3、5、10年的总生存率分别为77.64%、68.31%、39.26%,无瘤生存率分别为65.73%、57.17%、38.92%。Cox比例风险回归模型多因素分析结果显示:TNM分期、病理类型、神经侵犯、手术方式、放/化疗、局部复发及远处转移是影响患者术后生存的重要因素。结论 高TNM分期、实性病理类型、神经周围侵犯、有局部复发及远处转移等是涎腺ACC患者术后生存的危险因素,能缩短术后生存时间;手术加放/化疗是保护因素。?     

唾液腺腺样囊性癌p53基因突变及其与临床病理的关系

目的:研究唾液腺腺样囊性癌(ACC)p53基因突变及其与临床病理因素的关系。方法:选择38例唾液腺ACC病理标本,采用聚合酶链式反应单链构象多态性分析(PCR-SSCP)进行p53基因突变(5-8外显子)的检测;应用SPSS10.0统计学分析软件,采用Kaplan-Meier法进行生存分析,并绘制生存曲线。p53基因突变与ACC各病理类型、局部复发率、远处转移率及临床分期的关系采用Fisher精确检验。结果:p53基因5-8外显子突变检出率为65.8%,p53基因突变与唾液腺ACC的肿瘤复发、远处转移及术后生存有关(P<0.05),与肿瘤病理类型、临床分期无关(P>0.05)。结论:p53基因突变在唾液腺ACC中有较高的检出率,并可能与患者的预后有关。     

The significance of perineural spread in adenoid cystic carcinoma of the major and minor salivary glands

Patient survival, local recurrence and distant metastasis were studied in relation to the pathological finding of perineural spread in 37 patients with adenoid cystic carcinoma of the major and minor salivary glands. All patients underwent a combined surgical and radiotherapeutical treatment. The overall incidence of perineural invasion in primary resection specimens was 52.6%. The 5-year actuarial survival rate for patients with perineural invasion was significantly lower (p less than 0.001) than for those without (36.9% versus 93.8%). In 26 patients with resection margins free of tumour, recurrences developed in 9/11 (81.8%) of the patients with perineural invasion as opposed to 4/15 (26.7%) of the patients without perineural invasion (p = 0.005). In the same group with resection margins free of tumour, distant metastasis developed after the primary treatment in 4/10 (40.0%) of the patients with perineural invasion, while none of the 14 patients without perineural invasion experienced distant metastasis (p less than 0.0002). The incidence of perineural invasion increased with a higher stage of the primary tumour.     

Salivary gland tumours treated in the stomatological clinics in Bratislava.

During the period of 1951-1996 a group of 1021 patients (484 men and 537 women, mean age 53 years, range 2-87 years) with salivary gland tumours were analysed retrospectively. The mean follow-up period was 8 years (range 10 months-25 years). The frequency of benign tumours was 74% (n = 755) and malignant tumours 26% (n = 266). Lesions were sited in the parotid gland 83% (n = 847), in the submandibular gland 10.8% (n = 110), in the sublingual gland 3.2% (n = 33) and in the minor salivary glands 3% (n = 31). The most common benign tumours were pleomorphic adenoma in 53.9% (n = 550) and Warthin's tumour 9.7% (n = 99). Of the malignancies, the adenoid cystic carcinoma was most common (6.4% of cases, n = 65) and mucoepidermoid carcinoma occurred in 5.2% (n = 53). The predominant therapy was surgery alone or in combination with postoperative radiotherapy in 93.7% (957 cases), radiotherapy alone after fine needle aspiration biopsy for 4.7%, and 19 patients remained untreated.     

Neck involvement and disease recurrence in adenoid cystic carcinoma of the minor salivary glands: the role of surgery in primary and progressive disease

The aim of this study was to analyse the rates of metastatic events and clinical outcomes of patients with adenoid cystic carcinoma (ACC) of the minor salivary glands and to critically evaluate the role of surgical therapy. A retrospective cohort study was designed including all patients with ACC of the oral minor salivary glands treated in the study department during the years 2010–2017. Relevant clinicopathological data were analysed to determine factors with an impact on overall survival (OS) and progression-free survival (PFS). Forty-one patients with primary ACC of the oral cavity and the oropharynx were included. Cervical metastases were found in 14 patients (34.1%) and were shown to have a significant negative impact on OS (P = 0.009) and PFS (P = 0.03). Sixteen patients developed disease recurrence during follow-up (39.0%) and most patients exhibited local disease recurrence with or without regional or distant metastases (14/16, 87.5%). Local recurrence was treated successfully with surgery in five cases. We recommend surgical therapy for patients with ACC of the minor salivary glands, including elective neck dissection and microvascular reconstruction, to optimize the planning of adjuvant therapy.     

The role of radiotherapy in the management of salivary gland carcinomas.

A retrospective study was performed on 44 patients with carcinoma originating in the major and minor salivary glands to examine the effects of postoperative radiotherapy on locoregional and distant control and survival. 22 patients were treated by surgery alone and the 22 other patients were treated by a combination of surgery and postoperative irradiation. In the surgery group, local recurrence developed in all 8 patients with evidence of residual disease at the surgical margins, whereas local control was achieved in 7 of 15 patients with positive surgical margins in the combination group and the control rate was related to the amount of residual disease. Neck metastasis, which developed in 13 patients (30%), was not affected by the status of surgical margins or by the treatment modality. On the other hand, the incidence of distant metastasis seen in 19 patients (43%) was much higher in patients with positive surgical margins and the development of distant metastasis in these patients was not prevented by postoperative irradiation. The survival rates at 5, 10 and 15 years were 54, 48 and 41%, respectively, for the irradiated patients, whereas the values for the patients treated by surgery alone were 75, 70 and 70%, respectively. The results indicate that postoperative irradiation is effective in controlling local recurrence but not neck and distant metastases. Wide excision with sufficient surgical margins followed by postoperative radiotherapy and systemic chemotherapy are essential to obtain a better prognosis.     

Adenoid cystic carcinoma of the dorsum of the tongue: presentation of a case

Adenoid cystic carcinoma is the most frequent malignant neoplasm of minor salivary glands (76.5%); it is clinically characterized by slow growth, and its most frequent localization is the hard palate. Histopathologically it presents three patterns, cribriform, tubular and solid; the solid type is related to a poor prognostic contrary to the cribriform type, which has a better prognosis. Surgical excision with wide margins is the treatment of choice, if it metastasizes to lymph nodules, post surgical radiotherapy is recommended. A 19 year-old man presented a recurrent lesion on the dorsum of the tongue previously diagnosed as monomorphic adenoma. In a second biopsy it was diagnosed as adenoid cystic carcinoma. The following immunohistochemical studies were ordered: CALP, CEA, Epithelial Membrane Antigen, Glial Fibrilar Acid Protein, Ki67; all of these studies were positive and with different intensities, corroborating the diagnosis of adenoid cystic carcinoma. The patient had a recurrence after 2 years.