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

The treatment results and prognostic factors of adenoid cystic carcinoma of the salivary gland :analysis of 126 cases

Objective To summarize the results of treatment of adenoid cystic carcinoma of the salivary glands of head and neck and to evaluate factors implicated in local recurrence and survival. Methods A retrospective analysis was performed on 126 cases with adenoid cystic carcinoma of the salivary glands. Results The overall local recurrent rate was 35%. In 80% of cases, radiotherapy was effective. The overall 5 ,10 and 20 year accumulative survival were 81.7%,63.8% and 37.0%, respectively. The recurrence free accumulative survival of 5 ,10 ,and 20 year were 87.6%, 77.0%,and 73.1%,respectively.Overall local control rates of 5 ,10 ,and 20 year were 85.7%,60.1%,and 29.4%,respectively .Regional lymph node metastasis rate was 10%, lung metastasis 24%. Six prognostic variables were analysed for local recurrence and survival. There was impact of the treatment fashion, tumor histological features and marginal status on local recurrence; and that of tumor histological features ,surgical margin and regional lymph node status on the survival. Conclusions Adenoid cystic carcinoma of the salivary gland is a slow growing tumor. Surgery is the treatment of choice. Radiotherapy may control disease growth effectively. Combined modality is indicated for patients with positive surgical margin and locally advanced disease.