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[目的]探讨涎腺腺样囊性癌(salivary adenoid cystic carcinoma,SACC)远处转移的影响因素及其对预后的影响,为其合理治疗提供依据。[方法]回顾性分析122例SACC的临床和随访资料,分析远处转移的影响因素。计数资料采用χ~2检验或精确概率法,Kaplan-Meier法计算生存率,组间比较采用Log-rank对数秩检验,Cox比例风险模型进行多因素分析。[结果]中位随访时间86个月,随访过程中36例(29.5%)发现远处转移,其中31例(86.1%)出现肺转移。单因素分析显示临床分期、淋巴结转移、切缘状况和病理分级是远处转移的影响因素(P<0.05)。Cox模型多变量分析显示淋巴结转移和阳性切缘是SACC无远处转移生存时间的独立影响因素(P<0.05)。有远处转移SACC的5、10年生存率分别为61.1%、23.4%,无远处转移SACC的5、10年生存率分别为84.9%、68.9%,差异有统计学意义(P<0.001)。接受了化疗的远处转移SACC患者的5、10年生存率分别为72.7%、38.8%,而未接受后续化疗的远处转移SACC患者的5、10年生存率分别为56.0%、18.4%,但差异无统计学意义(P=0.213)。[结论 ]SACC容易发生远处转移,尤其是肺转移,其中淋巴结转移和阳性切缘是SACC发生远处转移重要的风险因素。远处转移SACC缺乏有效治疗手段,预后较差,化疗并不能改善其预后。
[Objective] To investigate the influential factors of distant metastasis of salivary adenoid cystic carcinoma (SACC) and its influence on prognosis, and to provide basis for its rational treatment. [Methods] The clinical and follow-up data of 122 patients with SACC were retrospectively analyzed to analyze the influencing factors of distant metastasis. Count data using χ ~ 2 test or exact probability method, Kaplan-Meier method to calculate the survival rate between groups using Log-rank log rank test, Cox proportional hazards model for multivariate analysis. [Results] The median follow-up time was 86 months. During follow-up, 36 cases (29.5%) were distantly metastasized and 31 (86.1%) had lung metastases. Univariate analysis showed that clinical stage, lymph node metastasis, margins and pathological grade were the influential factors of distant metastasis (P <0.05). Multivariate Cox regression analysis showed that lymph node metastasis and positive margins were independent predictors of distant metastasis-free survival in SACC patients (P <0.05). The 5-year and 10-year survival rates of distant metastasis SACC were 61.1% and 23.4% respectively. The 5-and 10-year 5-year and 10-year survival rates of SACC without distant metastasis were 84.9% and 68.9% respectively, with significant difference (P <0.001) . The 5-year and 10-year survival rates of distant metastatic SACC patients receiving chemotherapy were 72.7% and 38.8%, respectively. The 5-year and 10-year survival rates of patients with distant metastasis SACC who received no chemotherapy were 56.0% and 18.4% But the difference was not statistically significant (P = 0.213). [Conclusion] SACC is prone to distant metastasis, especially lung metastasis. The lymph node metastasis and positive margin are the important risk factors of distant metastasis of SACC. SACC distant metastasis lack of effective treatment, the prognosis is poor, chemotherapy and can not improve its prognosis.