涎腺导管癌临床病理特征及预后分析

Clinicopathological features and prognosis analysis of salivary duct carcinoma

摘要

目的 分析涎腺导管癌（salivary duct carcinoma，SDC）的临床病理特征及其预后相关因素。方法 本研究已通过单位伦理委员会审查批准，并获得患者知情同意。回顾性分析河北医科大学第四医院2014—2022年收治的30例SDC患者的临床资料，包括病历记录、病理诊断、免疫组化指标、治疗方式、随访资料等数据，采用SPSS 26.0软件处理数据并制作生存曲线，卡方检验分析免疫组化分类变量与SDC复发、转移的关系，单因素用于分析临床预后因子。结果 30例SDC患者中，男女比例5:1，中位年龄61.5岁，约60%发生于腮腺，其余发生于下颌下腺、舌下腺、腭部小涎腺等。其中，19例雄激素受体阳性，23例人表皮生长因子受体-2阳性，26例Ki-67阳性。术后随访18 ~ 94个月，中位随访37个月，复发13例，远端转移14例，5年总生存率31.2%。术后放疗及术后放化疗患者的总生存率高于单纯手术患者，其组间差异具有统计学意义（P = 0.027）。肿瘤T分期、淋巴结转移与预后生存率相关（P<0.05），Ki-67阳性细胞数 ≥ 40%与术后复发或转移有一定相关性（P = 0.025）。结论 根治性手术联合术后放疗、放化疗对提高SDC患者远期总生存率有益，肿瘤T分期、淋巴结转移情况可能是影响SDC患者预后的主要因素，Ki-67阳性细胞数 ≥ 40%的患者，易出现术后复发或转移。

Abstract

Objective To summarize the clinicopathological characteristics and prognostic factors of salivary duct carcinoma (SDC) patients. Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. The clinical data of 30 SDC patients who were admitted to the Fourth Hospital of Hebei Medical University from 2014 to 2022, including case records, pathological diagnoses, immunohistochemical indicators, treatment methods, follow-up data, and other data, were retrospectively analyzed. SPSS 26.0 software was used to process the data and construct relevant curves. The chi-square test was used to analyze the correlation between different immunohistochemical indices and the recurrence and metastasis of SDC, and a single factor was used to analyze clinical prognostic factors. Results Among the 30 SDC patients, the male-to-female ratio was 5∶1, with a median age of 61.5 years. Approximately 60% of cases occurred in the parotid gland, whereas the remainder occurred in the submaxillary gland, sublingual gland, or minor salivary gland. Among them, 19 patients were androgen receptor-positive, 23 patients were human epidermal growth factor receptor-2 positive, and 26 patients were Ki-67 positive. Postoperative follow-up was 18-94 months, with a median follow-up of 37 months. There were 13 cases of recurrence and 14 cases of distant metastasis. The 5-year overall survival rate was only 31.2%. The long-term survival of patients who underwent postoperative radiotherapy and chemoradiotherapy was better than that of patients who underwent surgery alone (P= 0.027). T stage and lymph node invasion were associated with prognosis and survival (P<0.05). There was a correlation between a Ki-67-positive cell count ≥ 40% and postoperative recurrence or metastasis (P = 0.025). Conclusion Radical surgery combined with postoperative radiotherapy and chemoradiotherapy is helpful for improving long-term overall survival, and tumor T stage and lymph node metastasis may be the main factors affecting the prognosis of patients with SDC. Patients with Ki-67-positive cell counts ≥ 40% are prone to postoperative recurrence or metastasis.

关键词

涎腺导管癌 / Ki-67 / 人表皮生长因子受体-2 / 雄激素受体 / T分期 / 淋巴结转移 / 生存率 / 预后

Key words

salivary duct carcinoma / Ki-67 / human epidermal growth factor receptor 2 / androgen receptor / T stage / lymph node invasion / survival rate / prognosis

Author summay

陈永强，医师，硕士，Email：[e-mail]