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目的:探讨Brandwein病理评分系统中各指标与唾液腺黏液表皮样癌(MEC)术后复发和转移的关系,比较不同病理评分系统分级的病理分级与唾液腺MEC患者术后复发和转移的关系。方法:对33例唾液腺MEC患者的临床病理资料进行回顾性研究,应用寿命表法计算术后的复发率和转移率,用Kaplan-Meier方法对影响术后复发和转移的各因素进行分析,采用Cox比例风险回归模型筛选影响术后复发和转移的危险因素。采用Kaplan-Meier方法,对不同病理评分系统分级的患者3、5、10年复发率和转移率进行比较。结果:33例唾液腺MEC患者术后3、5、10年复发率和转移率分别为8.05%、13.07%、56.17%和7.05%、12.07%、34.20%。单因素分析表明,神经侵犯、病理分级B(按Brandwein病理评分系统分级)等10个因素是MEC患者术后复发的重要因素;组织坏死、临床分期等11个因素是MEC患者术后转移的重要因素。多因素分析表明,病理分级B(P=0.027,OR>1)是MEC患者术后复发的主要影响因素,组织坏死(P=0.004,OR>1)是唾液腺MEC患者术后转移的主要影响因素。病理分级A(按AFIP病理评分系统分级)中,高分化MEC患者10年复发率为25.15%;病理分级B中,高分化MEC患者术后10年内无复发患者。病理分级A中,中分化MEC患者中5年转移率为50.35%,10年转移率为100%;病理分级B中,中分化MEC患者5年、10年内无复发患者。结论:唾液腺MEC患者随着时间的延长,其术后复发率和转移率逐渐增加,术后患者应进行长期随访。病理分级B是患者术后复发的独立危险因素,组织坏死是术后转移的独立危险因素。病理分级B可能是比病理分级A客观性更强的分级方法。
OBJECTIVE: To investigate the relationship between Brandwein pathological score system and recurrence and metastasis of salivary mucoepidermoid carcinoma (MEC), and to compare the pathological grading of different pathological grading system with the recurrence and metastasis of salivary gland MEC patients. Methods: The clinical and pathological data of 33 cases with salivary gland MEC were retrospectively studied. The recurrence rate and metastasis rate were calculated by life table method. The factors that affected the recurrence and metastasis were analyzed by Kaplan-Meier method. Cox proportional hazards regression model screening risk factors for postoperative recurrence and metastasis. The Kaplan-Meier method was used to compare the rates of recurrence and metastasis at 3, 5, and 10 years in patients with different pathological grading systems. Results: The recurrence rates and metastatic rates at 3, 5 and 10 years in 33 salivary gland patients with MEC were 8.05%, 13.07%, 56.17% and 7.05%, 12.07% and 34.20% respectively. Univariate analysis showed that 10 factors such as nerve invasion and histopathological grade B (grading by Brandwein pathological grading system) were the important factors of postoperative recurrence in MEC patients. Eleven factors such as tissue necrosis and clinical stage were important for the postoperative metastasis of MEC patients factor. Multivariate analysis showed that pathological grade B (P = 0.027, OR> 1) was the main influencing factor of postoperative recurrence in MEC patients. Tissue necrosis (P = 0.004, OR> 1) was the main influencing factor of postoperative metastasis in MEC patients . The pathological grade A (graded according to the AFIP pathological grading system) showed that the 10-year recurrence rate of well-differentiated MEC patients was 25.15%. In pathological grade B, patients with well-differentiated MEC patients had no recurrence within 10 years after operation. Pathological grade A, moderately differentiated MEC patients with 5-year transfer rate was 50.35%, 10-year transfer rate was 100%; pathological grade B, moderately differentiated MEC patients for 5 years, 10 years without recurrence. CONCLUSIONS: The salivary gland MEC patients’ recurrence rate and metastasis rate gradually increase with the prolongation of time. Postoperative patients should be followed up for a long time. Pathological grade B is an independent risk factor for postoperative recurrence. Tissue necrosis is an independent risk factor for postoperative metastasis. Pathological grade B may be a more objective method of classification than pathology grade A.