国际肿瘤学杂志

国际肿瘤学杂志 ›› 2015, Vol. 42 ›› Issue (10): 726-729.doi: 10.3760/cma.j.issn.1673-422X.2015.10.002

• 论著 • 上一篇    下一篇

腮腺黏液表皮样癌单纯手术和术后辅助放化疗疗效和预后因素分析

韦存志 蔡德丰 屈进文 肖世强 王建洪   

  1. 644000 四川省宜宾市第一人民医院口腔科（韦存志），耳鼻喉头颈外科（屈进文、肖世强、王建洪）；四川省宜宾肿瘤医院肿瘤科（蔡德丰）
  • 出版日期:2015-10-08 发布日期:2015-09-08
  • 通讯作者: 韦存志 E-mail:weicunzhi666666@126.com

Therapeutic effect and prognostic factors for patients with mucoepidermoid carcinoma of parotid gland

Wei Cunzhi, Cai Defeng, Qu Jinwen, Xiao Shiqiang, Wang Jianhong   

  1. Department of Stomatology, First People′s Hospital of Yibin, Sichuan Province, Yibin 644000, China 
  • Online:2015-10-08 Published:2015-09-08
  • Contact: Wei Cunzhi E-mail:weicunzhi666666@126.com

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摘要： 目的 探讨术后辅助放化疗对腮腺黏液表皮样癌患者的疗效，并进一步筛选出与肿瘤预后有关的指标。方法 选取2005年1月—2009年12月在四川省宜宾市第一人民医院治疗的80例腮腺黏液表皮样癌患者作为研究对象，回顾性分析单纯手术（30例）或术后辅助治疗（50例）患者的生存情况，并进一步分析患者年龄、性别、吸烟、饮酒、淋巴结转移情况、远隔脏器转移情况、治疗方法、分化程度和T分级等变量与患者预后的关系。结果 Kaplan-Meier生存曲线显示，术后辅助放化疗患者的PFS和OS均长于单纯手术治疗患者（94.4个月∶69.3个月；114.9个月∶96.7个月），差异均有统计学意义（χ2=11.246，P=0.001；χ2=15.803，P=0.001）。COX单因素分析结果表明，性别（χ2=22.346，P=0.000）、吸烟（χ2=7.891，P=0.041）、淋巴结转移（χ2=12.371，P=0.005）、远隔脏器转移（χ2=9.813，P=0.002）、治疗方法（χ2=25.261，P=0.000）、分化程度（χ2=4.361，P=0.006）和T分级（χ2=5.336，P=0.014）与患者PFS有关。进一步多因素分析发现，淋巴结转移（χ2=11.003，RR=2.827，95%CI为1.965～3.851，P=0.011）、远隔脏器转移（χ2=7.611，RR=0.472，95%CI为0.240～0.775，P=0.016）、治疗方法（χ2=24.542，RR=5.390，95%CI为3.585～9.602，P=0.000）、分化程度（χ2=3.221，RR=2.118，95%CI为1.845～4.719，P=0.009）和T分级（χ2=4.336，RR=0.804，95%CI为0.681～0.916，P=0.024）与患者PFS有关。COX单因素分析结果表明，吸烟（χ2=4.551，P=0.008）、饮酒（χ2=11.742，P=0.048）、淋巴结转移（χ2=14.886，P=0.009）、远隔脏器转移（χ2=6.713，P=0.005）、治疗方法（χ2=22.411，P=0.000）、分化程度（χ2=8.116，P=0.012）和T分级（χ2=14.443，P=0.035）与患者OS有关。进一步多因素分析发现淋巴结转移（χ2=11.711，RR=2.985，95%CI为1.521～3.999，P=0.005）、远隔脏器转移（χ2=5.390，RR=0.400，95%CI为0.201～0.793，P=0.009）、治疗方法（χ2=19.327，RR=5.086，95%CI为3.241～8.006，P=0.000）、分化程度（χ2=7.084，RR=2.301，95%CI为1.908～4.503，P=0.001）和T分级（χ2=13.229，RR=0.561，95%CI为0.348～0.867，P=0.040）与患者OS有关。结论 术后辅助放化疗能明显延长腮腺黏液表皮样癌患者的PFS和OS。淋巴结转移、远隔脏器转移、治疗方法、分化程度和T分级对腮腺黏液表皮样癌患者的预后具有较大的影响，可以作为腮腺黏液表皮样癌患者预后的独立指标。

关键词: 黏液表皮样瘤, 治疗结果, 预后

Abstract: Objective To study the therapeutic effect of adjuvant chemotherapy and radiotherapy after operation in patients with mucoepidermoid carcinoma of parotid gland, and to screen the indicators ralated to the prognosis of tumor. Methods Eighty patients with mucoepidermoid carcinoma of parotid gland in First People′ Hospital of Yibin of Sichuan Province from January 2005 to December 2009 were analysed retrospectively in our research. We studied the survival of patients who were treated wtih simple operation(30 cases) or postoperative adjuvant therapy(50 cases). Then we further analyzed the relationships between the prognosis of the patients and some variables (age, gender, smoking, alcohol drinking, lymph node metastasis, distant organ metastasis, treatment method, differentiation degree and T grading). Results Kaplan-Meier survival curves showed that patients with postoperative adjuvant therapy had longer PFS and OS than those without adjuvant therapy (94.4 months vs 69.3 months; 114.9 months vs 96.7 months), with statistical significance (χ2=11.246, P=0.001; χ2=15.803, P=0.001). COX univariate analysis showed that gender (χ2=22.346, P=0.000), smoking (χ2=7.891, P=0.041), lymph node metastasis (χ2=12.371, P=0.005), distant organ metastasis (χ2=9.813, P=0.002), treatment method (χ2=25.261, P=0.000), differentiation degree (χ2=4.361, P=0.006) and T grading (χ2=5.336, P=0.014) were related to the PFS of patients. COX multivariate analysis showed that lymph node metastasis (χ2=11.003, RR=2.827, 95%CI: 1.9653.851, P=0.011), distant organ metastasis (χ2=7.611, RR=0.472, 95%CI: 0.2400.775, P=0.016), treatment method (χ2=24.542, RR=5.390, 95%CI: 3.5859.602, P=0.000), degree of differentiation (χ2=3.221, RR=2.118, 95%CI: 1.8454.719, P=0.009) and T grading (χ2=4.336, RR=0.804, 95%CI: 0.6810.916, P=0.024) were related to the PFS of patients. COX univariate analysis showed that smoking (χ2=4.551, P=0.008), alcohol drinking (χ2=11.742, P=0.048), lymph node metastasis (χ2=14.886, P=0.009), distant organ metastasis (χ2=6.713, P=0.005), treatment method (χ2=22.411, P=0.000), degree of differentiation (χ2=8.116, P=0.012) and T grading (χ2=14.443, P=0.035) were related to the OS of patients. COX multivariate analysis showed that lymph node metastasis (χ2=11.711, RR=2.985, 95%CI: 1.5213.999, P=0.005), distant organ metastasis (χ2=5.390, RR=0.400, 95%CI:0.2010.793, P=0.009), treatment method (χ2=19.327, RR=5.086, 95%CI: 3.2418.006, P=0.000), degree of differentiation (χ2=7.084, RR=2.301, 95%CI: 1.9084.503, P=0.001) and T grading (χ2=13.229, RR=0.561, 95%CI: 0.3480.867, P=0.040) were related to the OS of patients. Conclusion Adjuvant radiation and chemotherapy can obviously prolong the PFS and OS for the patients with mucoepidermoid carcinoma of parotid gland. Lymph node metastasis, distant organ metastasis, treatment method, differentiation degree and T grading can greatly influence the prognosis of patients with mucoepidermoid carcinoma of parotid gland, which can be used as independent prognostic indicators for the patients with mucoepidermoid carcinoma of parotid gland.

Key words: Mucoepidermoid tumor, Treatment outcome, Prognosis