早期韦氏环弥漫大B细胞淋巴瘤预后分析

目的 分析早期韦氏环弥漫大B细胞淋巴瘤(WR-DLBCL)接受CHOP为主治疗的疗效及预后因素。方法 2006-2018年间收治137例确诊为WR-DLBCL患者,其中Ⅰ期22例,Ⅱ期115例。全组接受了CHOP类为主方案化疗,其中62例使用了利妥昔单抗,87例接受了累及野放疗。Kaplan-meier法计算总生存(OS)、无进展生存(PFS)、无局部区域复发生存(LRRFS),并Logrank法检验和单因素分析,Cox模型多因素分析。结果 全组5年OS、PFS、LRRFS分别为78.6%、69.5%、83.2%,综合治疗组分别为87.5%、80.2%、90.9%,单纯化疗组分别为64.2%、53.6%、72.9%。单因素分析显示乳酸脱氢酶、国际预后指数评分、大肿块、利妥昔单抗、化疗周期及综合治疗是影响OS、PFS因素;乳酸脱氢酶、大肿块、综合治疗是影响LRRFS因素。多因素分析显示乳酸脱氢酶、综合治疗模式、利妥昔单抗是影响OS因素,LDH、综合治疗模式是影响PFS因素,LDH是影响LRRFS因素。结论 早期WR-BLBCL预后良好,在利妥昔单抗治疗的时代,化疗联合放疗的综合治疗方式仍然是早期WR-BLBCL的有效手段。     

早期韦氏环弥漫大B细胞淋巴瘤预后分析

目的 分析早期韦氏环弥漫大B细胞淋巴瘤(WR-DLBCL)接受CHOP为主治疗的疗效及预后因素。方法 2006-2018年间收治137例确诊为WR-DLBCL患者,其中Ⅰ期22例,Ⅱ期115例。全组接受了CHOP类为主方案化疗,其中62例使用了利妥昔单抗,87例接受了累及野放疗。Kaplan-meier法计算总生存(OS)、无进展生存(PFS)、无局部区域复发生存(LRRFS),并Logrank法检验和单因素分析,Cox模型多因素分析。结果 全组5年OS、PFS、LRRFS分别为78.6%、69.5%、83.2%,综合治疗组分别为87.5%、80.2%、90.9%,单纯化疗组分别为64.2%、53.6%、72.9%。单因素分析显示乳酸脱氢酶、国际预后指数评分、大肿块、利妥昔单抗、化疗周期及综合治疗是影响OS、PFS因素;乳酸脱氢酶、大肿块、综合治疗是影响LRRFS因素。多因素分析显示乳酸脱氢酶、综合治疗模式、利妥昔单抗是影响OS因素,LDH、综合治疗模式是影响PFS因素,LDH是影响LRRFS因素。结论 早期WR-BLBCL预后良好,在利妥昔单抗治疗的时代,化疗联合放疗的综合治疗方式仍然是早期WR-BLBCL的有效手段。     

乳腺癌根治术后单纯胸壁复发放疗和胸壁再复发的预后分析

目的 探究乳腺癌根治术后单纯胸壁复发(ICWR)患者的照射野及剂量选择,同时分析胸壁再复发的预后因素。方法 回顾性分析1998—2018年间解放军总医院第五医学中心和医科院肿瘤医院收治的乳腺癌改良根治术后ICWR患者 201例,患者术后均未行辅助放疗。胸壁复发后 48例(73.6%)患者接受手术治疗,155例(77.1%)患者接受放疗。无进展生存(PFS)率的计算采用Kaplan-Meier法和log-rank检验,多因素分析采用Cox回归法。胸壁再复发的计算采用竞争风险模型和Gray检验,多因素分析采用F&G回归法。结果 复发后中位随访时间92.8个月,5年PFS率为23.2%,5年胸壁再复发率为35.7%。多因素分析显示联合手术+放疗和复发间隔时间>12个月患者有较低的胸壁再复发率,复发间隔时间>48个月、联合局部+全身治疗及联合手术+放疗的患者有较高PFS率。155例患者ICWR后接受胸壁放疗,全胸壁照射+局部补量比全胸壁照射可以改善首次胸壁复发后的 5年PFS率(34.0%∶15.4%,P=0.004)。胸壁放疗剂量(≤60Gy∶>60Gy)对胸壁再复发率及PFS率无明显影响(P>0.05)。53例未手术患者胸壁瘤床剂量≤60Gy和>60Gy的 5年PFS率分别为9.1%和20.5%(P=0.061)。结论 乳腺癌根治术后ICWR患者局部放疗建议包括全胸壁照射+局部补量,复发灶剂量需加至60Gy,对未行手术切除者需>60Gy。ICWR患者仍有较高的胸壁再复发风险,需要探索更有效的治疗方法。     

IMRT同期化疗在Ⅲ期鼻咽癌中作用分析

目的 探讨IMRT同期化疗对Ⅲ期鼻咽癌患者预后的影响和作用。方法 回顾性分析2001-2008年间中山大学肿瘤防治中心接受单纯IMRT和IMRT同期铂类药物化疗的 251例Ⅲ期鼻咽癌患者,分析相关预后因子和探讨IMRT同期化疗作用。采用Kaplan-Meier法计算生存率,组间差异比较采用log-rank检验,Cox模型预后因素分析。结果 全组 10年无局部区域复发生存(LRFS)、无远处转移生存(DMFS)、无进展生存(PFS)和总生存(OS)率分别为88.6%、81.1%、68.8%和75.1%。单因素和多因素分析显示N分期和鼻咽肿瘤体积是最重要的预后影响因素,同期化疗有助于改善患者PFS和OS (均 P<0.05)。T3N0-1期患者单纯放疗组和同期放化疗组各生存指标均相近(10年LRFS为93.8%∶93.2%,P=0.933;10年DMFS为80.9%∶86.8%,P=0.385;10年PFS为70.6%∶77.7%,P=0.513;10年OS为71.8%∶83.6%,P=0.207);T1-3N2期患者同期放化疗的LRFS、PFS和OS优于单纯放疗(10年LRFS为87.3%∶66.7%,P=0.016;10年PFS为70.2%∶41.0%,P=0.003;10年OS为78.5%∶51.7%,P=0.008),DMFS有提高趋势(10年DMFS为80.3%∶66.4%,P=0.103)。结论 IMRT中同期化疗的加入有助于改善Ⅲ期鼻咽癌患者预后,在N2期组获益较为明显,需要根据患者治疗失败风险予以个体化治疗方案。     

胸部3DCRT在广泛期SCLC中的应用研究

目的 评价胸部3DCRT在广泛期SCLC中的价值。方法 选择2004—2009年间收治的171例广泛期SCLC患者纳入研究,其中86例接受胸部3DCRT和全身化疗,85例只接受全身化疗。放疗采用超分割(1.5 Gy/次,2 次/d)或常规分割(2.0 Gy/次,1 次/d)方式,总量40~62 Gy。化疗方案为铂类联合依托泊甙。生存计算采用Kaplan-Meier法并Logrank检验和单因素预后分析,Cox模型多因素预后分析。结果 随访率为100%。全组中位OS期、2年OS率、5年OS率全组分别为15个月、31.5%、2.4%,放疗组的分别为18个月、35.3%、2.4%,化疗组的分别为12个月、14.5%、2.4%(P=0.023)。全组中位PFS期、1年PFS率、2年PFS率全组分别为8个月、27.5%、2.4%,放疗组的分别为9个月、35.4%、6.0%,化疗组的分别为6个月、20.5%、6.0%(P=0.004)。放疗组中超分割总量45 Gy的22例患者中位PFS期11个月,常规分割总量60 Gy的26例患者中位PFS期9个月(P=0.037)。多因素分析显示3DCRT、4周期以上化疗是预后有利因素(P=0.008、0.001)。结论 胸部放疗能改善广泛期SCLC患者OS和PFS,总量45 Gy超分割放疗较佳。胸部放疗和4周期以上化疗对OS是独立的预后有利因素。     

复发脑胶质瘤再程放疗的远期疗效分析

目的 分析复发脑胶质瘤行再程放疗的远期疗效及不良反应。方法 收集2009-2019年间行再程放疗的52例复发脑胶质瘤患者的资料,再程放疗中位计划靶区体积(PTV)73.5cm³(49.9~102.7cm³),中位剂量45.0Gy (43.0~48.8Gy)。Kaplan-Meier法计算总生存(OS)和无进展生存(PFS)期并Log-rank检验,Cox模型多因素预后分析。结果 中位随访32.6个月,全组患者中位OS和中位PFS期分别为16.1个月(95%CI为4.1~28.1)和8.0个月(95%CI为4.0~12.0),1、2、3年OS率分别为67%、43%、29%,6个月、1年、2年PFS率分别为67%、40%、26%。多因素分析KPS评分、复发时间显著影响OS (P=0.012、P=0.001);KPS评分、两次放疗间隔时间显著影响PFS (P=0.003、P=0.018)。分层分析提示再放疗时KPS评分为初始病理WHOⅡ级和复发后再次手术患者OS及PFS的影响因素(P<0.001,P=0.012);复发时临床表现为初始病理WHOⅢ、Ⅳ级患者OS及PFS的影响因素(P=0.006、P=0.044)。不良反应总发生率为30.8%,1级占25.0%,2级占5.8%。结论 再程放疗复发脑胶质瘤具有较好的远期疗效,不良反应可耐受。     

基于鼻咽癌临床Ⅲ期探讨第8版AJCC/UICC分期系统

目的 基于调强放疗临床Ⅲ期鼻咽癌的生存分析中探讨第8版AJCC/UICC鼻咽癌分期系统。方法 2008-2014年在汕头大学医学院附属肿瘤医院首次治疗的 1351例鼻咽癌患者中按第7、8版标准重新分期,确定Ⅲ期患者分别为742、784例,将其各自分为3个亚组:T3N0-1期为 G1(226、245例),T1-2N2期为 G2(180、187例),T3N2期为G3(336、352例)。Kaplan-Meier法分别计算3个组 5年总生存(OS)、无进展生存(PFS)、无远处转移生存(DMFS)、无局部区域复发生存(LRRFS),并log-rank检验组间差异。结果 第8版病例中93.6%与第7版的相同。第8版与第7版总体的OS、PFS、DMFS、LRRFS分别为84.8%与85.4%、76.2%与77.0%、80.4%与81.3%、89.8%与90.6%(P均>0.05)。第8版分期3个亚组的OS、PFS和DMFS均不同(P均<0.001);G1与 G2、G1与G3也不同(P均<0.05),G2与G3间相近(P=0.183、0.310、0.248)。结论 第8版AJCC/UICC分期系统对临床Ⅲ期病例的分布特点及临床终点相对于第7版变化不大,亚组间仍有明显的组内生存风险分布差异,其中N2对Ⅲ期患者的生存风险评估起到主要作用。可能在IMRT联合化疗时代局部肿瘤对预后的影响已经减弱,第8版分期系统仍然有改进的空间。     

早期结外NK/T细胞淋巴瘤的预后分析

目的 分析早期上呼吸消化道结外NK/T细胞淋巴瘤(UADT ENKTCL)放疗联合以门冬酰胺酶/培门冬酶为主的化疗疗效及预后因素。方法 收集2003—2020年间贵州省肿瘤医院收治的 267例早期UADT ENKTCL患者,其中放疗或联合门冬酰胺酶/培门冬酶为主要方案化疗的 229例,单纯放疗或化疗的 38例。Kaplan-Meier计算总生存(OS)、无进展生存(PFS)并log-rank法检验和单因素分析,Cox模型多因素分析。结果 全组 5年OS、PFS分别为67.2%、61.5%;放化综合治疗、单纯放疗、单纯化疗的 5年OS分别为71.7%、35%、49%(P<0.001),5年PFS分别为66%、35%、28%(P<0.001)。放化疗患者基于NRI危险分层分为预后良好、预后不良组,5年OS分别为93.3%、64.3%(P<0.001),5年PFS分别为91.1%、56.7%(P<0.001);放疗剂量≥50Gy、<50Gy组 5年OS分别为72.4%、55.7%(P<0.001),5年PFS分别为68.3%、36.5%(P<0.001)。预后不良组化疗周期数≥4个、<4个的 5年OS分别为65.5%、59.2%(P=0.049),5年PFS分别为60.7%、50.6%(P=0.018)。单因素分析显示Ⅱ期、ECOG≥2分、超腔、单纯放疗、NRI≥1分、EB病毒-DNA≥2750 copies/ml、放疗剂量<50Gy,化疗周期数<4个为 5年OS及PFS的预后不良因素(均 P<0.05);CHOP类化疗方案仅为PFS的预后不良因素(P<0.05)。多因素分析显示超腔、ECOG≥2分、放疗剂量<50Gy均为OS和PFS的预后不良因素(均 P<0.05),Ⅱ期为OS的预后不良因素(P<0.05)。结论 早期低危UADT ENKTCL预后良好;足够剂量的扩大受累野放疗是早期UADT ENKTCL根治性手段;综合治疗较单纯放疗能改善早期预后不良组患者的预后;足疗程化疗能显著改善预后不良组的远期生存,门冬酰胺酶为基础的化疗均能较好的改善早期UADT ENKTCL的预后。     

头颈部黏膜恶性黑色素瘤手术联合放疗的预后分析

目的 探讨头颈部黏膜恶性黑色素瘤手术联合放疗的综合治疗模式的效果和失败模式,并分析影响预后的因素。方法 回顾分析1982-2017年收治的194例无远处转移的头颈部黏膜恶性黑色素瘤患者的病历资料。分析综合治疗模式的效果、失败模式及预后影响因素。结果 全组患者5年总生存、无局部复发生存、无区域复发生存和无远处转移生存率分别为41.4%、57.8%、76.5%和46.5%。194例患者中治疗失败141例,失败率为74.6%,其中首次失败为远处转移的患者占40%(56/141),首次失败为局部失败的患者占37%(52/141),首次失败为区域失败的患者占15%(21/141),同时合并远处转移和局部失败的患者占5%(7/141),同时合并局部失败和区域失败的患者占3%(5/141)。Cox多因素结果显示手术切缘和联合放疗是影响局部控制的独立预后因素(P=0.001、P=0.000)。结论 头颈部黏膜恶性黑色素瘤手术联合放疗的综合治疗模式可以获得较好的局部控制率,远处转移仍是其主要失败模式。     

靶向治疗对HER-2阳性改良根治术后未放疗乳腺癌患者复发影响——单中心大宗病例倾向评分匹配回顾分析

目的 评估乳腺癌抗HER-2靶向治疗的局部区域作用及对放疗决策的影响。方法 回顾分析2009-2014年本中心诊治的HER-2阳性、改良根治术后未放疗患者 1398例,其中接受辅助靶向者 370例。靶向治疗以单药曲妥珠单抗为主。结果 接受靶向治疗显著改善无瘤生存、总生存,也降低局部区域复发(LRR),多因素分析发现靶向治疗提高LRRFS (P=0.06)。倾向评分匹配其他预后因素后,有、无靶向治疗 5年LRR率分别为4.4%、6.6%(P=0.070)。亚组分析显示靶向治疗的局控优势在病理分级Ⅰ-Ⅱ级患者中显著(2.5%、5.9%,P=0.046);而原本需考虑放疗的亚组(pN1)靶向治疗后复发风险依旧相对高,有、无靶向治疗 5年LRR率分别为8.2%、12.3%(P=0.150)。激素受体阳性者靶向治疗的获益明显。接受靶向治疗且有良好预后因素的患者 5年LRR率可在5%以下。结论 以单药曲妥珠单抗为主的抗HER-2靶向治疗可提高改良根治术后患者LRRFS,但有放疗适应证的患者因复发率较高暂不能免于放疗,新开展的双单抗辅助靶向有望进一步改善局控,亦需进一步亚组分析寻找低危患者。     

乳腺癌同侧锁骨上转移淋巴结不同局部治疗模式的比较

目的:探讨乳腺癌同时型同侧锁骨上淋巴结转移(sISLM)患者锁骨上淋巴结的最佳局部治疗模式。方法:回顾性分析2010—2015年间河北医科大学第四医院收治的128例sISLM乳腺癌患者,其中锁骨上淋巴结清扫联合放疗组68例,单纯放疗组60例。比较两组患者的无局部区域复发生存(LRFS)、无远处转移生存(DMFS)、无进...     

Long-term treatment outcome of minor salivary gland carcinoma of the hard palate

Minor salivary gland carcinoma of the hard palate is rare, and its long-term survival rate is high, making it difficult to evaluate the prognostic factors and the efficacy of treatment. This study was designed to evaluate the treatment outcome of minor salivary gland carcinoma of the hard palate. 103 cases of minor salivary gland carcinoma of the hard palate treated with surgery alone or underwent surgery combined with post-operative radiotherapy hospitalized in Cancer Center, Sun Yet-Sen University, from 1968 to 2008 were reviewed retrospectively. The most common histologic types were adenoid cystic carcinoma in 48 patients(46.6%), mucoepidermoid carcinoma in 37(35.92%), malignant mixed tumor in 15(14.56%), and acinic cell carcinoma in 3(2.91%). The median follow-up time was 74.83 months (range 0.9-356.57 months). Overall outcomes at 5 and 10 years were overall survival (OS), 77.9% and 65.7%; recurrence-free survival (RFS), 64.4% and 53.2%; and disease specific survival (DSS), 77.9% and 67.7%, respectively. There was no significant difference in overall survival (P=0.52), recurrence-free survival (P=0.762) and disease specific survival (P=0.449) between patients who underwent surgery alone and those who underwent surgery plus post-operative radiotherapy. Surgery has been accepted as the primary treatment for minor salivary gland carcinoma of hard palate. Sufficient surgical excision with adequate margins is essential for a favorable outcome. We advocate using radiotherapy in the post-operative context for patients with poorly differentiated, cervical lymph node metastasis, positive or close margins, and large primary lesions.     

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.     

Long-term outcome of patients treated by radiation therapy alone for salivary gland carcinomas

PURPOSE: To review a single-institution experience with the management of salivary gland cancers treated by radiation alone. METHODS AND MATERIALS: Between 1960 and 2004, 45 patients with newly diagnosed salivary gland carcinomas were treated with definitive radiation to a median dose of 66 Gy (range, 57-74 Gy). Distribution of T-stage was: 24% T1, 18% T2, 31% T3, and 27% T4. Histology was: 14 mucoepidermoid (31%), 10 adenocarcinoma (22%), 8 adenoid cystic (18%), 4 undifferentiated (9%), 4 acinic (9%), 2 malignant mixed (4%), 2 squamous (4%), and 1 salivary duct carcinoma (2%). No patient had clinical or pathologic evidence of lymph node disease. Median follow-up was 101 months (range, 3-285 months). RESULTS: The 5-year and 10-year rate estimates of local control were 70% and 57%, respectively. A Cox proportional hazard model identified T3-4 disease (p = 0.004) and radiation dose lower than 66 Gy (p = 0.001) as independent predictors of local recurrence. The 10-year overall survival and distant metastasis-free rates were 46% and 67%, respectively. CONCLUSION: Radiation therapy alone is a reasonable alternative to surgery in the definitive management of salivary gland cancers and results in long-term survival in a significant proportion of patients. Radiation dose in excess of 66 Gy is recommended.     

Role of radiotherapy for mucoepidermoid carcinoma of salivary gland

This report analyzes 61 patients with mucoepidermoid carcinomas of the salivary gland treated by surgery alone or by surgery plus radiotherapy. Local control for all 61 patients at 5 and 10 years was achieved for 88.8 and 79.7% of the cases. Although the rate of positive surgical margin was higher in patients treated with surgery and radiotherapy (radiotherapy group) than in patients treated by surgery alone (surgery group), the local control rates of the two groups showed no statistically significant differences. There was no local recurrence in seven patients receiving post-operative radiotherapy above 55 Gy while there were three local relapses among 17 patients receiving 55 Gy or lower doses (P < 0.05). The 5- and 10-year actual survival rates were 73.4 and 63.3% respectively. Histopathologic subtype of mucoepidermoid carcinomas correlated with regional lymph node involvement and survival. There were no differences in the local control and survival rates of patients with major salivary gland tumors and patients with minor salivary gland tumors. Radiotherapy using 55 Gy or more combined with operation achieved local control and survival rates comparable with complete resection of tumors even if a positive surgical margin was more frequent in the radiotherapy groups.     

嗜神经侵袭阳性鼻腔副鼻窦腺样囊性癌的治疗及预后分析

目的分析嗜神经侵袭(PNI)阳性鼻腔副鼻窦腺样囊性癌(ACC)的疗效, 探讨PNI在鼻腔副鼻窦ACC中的预后价值。方法回顾性分析2000年1月至2016年12月中国医学科学院肿瘤医院收治的105例鼻腔副鼻窦ACC患者的临床资料。按照美国癌症联合委员会和国际抗癌联盟第8版分期系统重新分期。随访获取患者治疗失败和生存资料, 预后影响因素的单因素分析采用Log rank检验, 多因素分析采用Cox回归比例风险模型。结果上颌窦(59例)为最常见的肿瘤原发部位, 其次为鼻腔(38例)。Ⅲ～Ⅳ期患者93例。治疗方式包括单纯手术14例, 单纯放疗13例, 术前放疗+手术10例, 手术+术后放疗68例。中位随访91.8个月, 5年局部控制率、无远处转移生存率、无进展生存率和总生存率分别为72.6%、73.0%、52.9%和78.0%。33例(31.4%)患者PNI阳性, 其5年无远处转移生存率、无进展生存率和总生存率分别为53.7%、29.4%和56.5%, 均低于PNI阴性组(分别为80.8%、63.0%和86.8%, 均P<0.05), 而两组的局部控制率差异无统计学意义(64.5%和76....     

The role of postoperative radiation therapy in carcinoma ex pleomorphic adenoma of the parotid gland

PURPOSE: To evaluate the impact of postoperative radiation therapy on the clinical course of patients with carcinoma ex pleomorphic adenoma of the parotid gland. METHODS AND MATERIALS: Between 1960 and 2004, 63 patients were treated with definitive surgery for carcinoma ex pleomorphic adenoma of the parotid gland. Forty patients (63%) received postoperative radiation therapy to a median dose of 60 Gy (range, 45-71 Gy). Adenocarcinoma (29 patients), salivary duct carcinoma (16 patients), and adenoid cystic carcinoma (9 patients) were the most common malignant subtypes. Pathologic T -stage was: 16% T1, 33% T2, 32% T3, and 19% T4. Twenty-one patients (33%) had microscopically positive margins and 39 (62%) had perineural invasion. Median follow-up was 50 months (range, 2-96 months). RESULTS: The use of postoperative therapy significantly improved 5-year local control from 49% to 75% (p = 0.005) and was associated with an improvement in survival among patients without evidence of cervical lymph node metastasis (p = 0.01). A Cox proportional hazard model identified pathologic involvement of cervical lymph nodes as an independent predictor of overall survival. Overall survival was 16% for patients with pathologic N-positive disease compared with 67% for those whose lymph node status was negative or unknown (p = 0.001). CONCLUSION: Surgery followed by postoperative radiation should be considered the standard of care for patients with carcinoma ex pleomorphic adenoma.     

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     

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.     

High expression of MMP-9 is associated with better prognosis in extrahepatic bile duct cancer patients

Purpose

To evaluate the prognostic value of matrix metalloproteinase-9 (MMP-9) in patients with extrahepatic bile duct (EHBD) cancer undergoing surgical resection and adjuvant radiotherapy.