唾液腺腺样囊性癌淋巴结转移相关的临床病理分析

doi:10.19723/j.issn.1671-167X.2020.01.005

摘要/Abstract

摘要：

目的:回顾性分析唾液腺腺样囊性癌颈部淋巴结转移的发病率及其临床病理特征。方法:回顾性分析2001年1月至2019年1月在北京大学口腔医院诊治并经病理确诊为腺样囊性癌的798例患者的临床病理资料,对82例发生颈部淋巴结转移的患者进行详细的临床病理及统计学分析。结果:纳入研究的腺样囊性癌患者798例,腭部、舌下口底区域和腮腺区是腺样囊性癌常见的发病部位。经病理学检查证实发生颈部淋巴结转移者82例,总体转移率约10.3%(82/798),其中原发于颌下腺、舌下口底区及舌部的颈部淋巴结转移率较高,分别为20.8%、16.1%、15.1%,而腭部、腮腺原发病例颈部淋巴结转移率较低,分别为6.1%、3.4%。颈Ⅰ、Ⅱ区为常见转移区域,极少累及Ⅳ、Ⅴ区淋巴结。主要转移模式是由癌细胞沿经典的淋巴管/血管通路转移(70.7%),部分颌下及舌下病例不除外直接侵犯淋巴结。82例伴淋巴结转移的患者5年和10年总生存率分别为77.4% 和 20.6%。淋巴结转移阳性组患者总生存率和无瘤生存率均显著低于转移阴性组,且组织学呈现实性型的腺样囊性癌颈部淋巴结转移率显著高于筛孔型和管状型肿瘤。结论:舌下、口底及颌下腺为唾液腺腺样囊性癌颈部淋巴转移常见原发部位,实性型组织学结构与转移率显著正相关,在临床诊治及随访中需要更多关注。

关键词: 唾液腺, 癌, 腺样囊性, 淋巴结, 肿瘤转移, 病理学, 临床

Abstract:

Objective: To investigate the incidence and clinicopathologic features of cervical lymph node metastasis in salivary gland adenoid cystic carcinoma (AdCC). Methods: Retrospective analysis was made in 798 AdCC patients who underwent tumor resection during January, 2001 to January, 2019 in Peking University School and Hospital of Stomatology, especially the clincopathologic characteristics of 82 cases with lymph node metastasis. Results: In the study, 82 of the 798 patients were identified with cervical lymph node metastasis, which was confirmed by histopathological examination. The palate, the region of sublingual gland and mouth floor, and the parotid were the frequently involved primary sites for AdCCs. The general incidence rate of lymph node metastasis was approximately 10%. The submandibular gland, the region of sublingual gland and mouth floor, and the mobile tongue were the most frequent sites of lymph node metastasis with the incidence rates of 20.8%, 16.1%, and 15.1%, respectively; while lymph node metastasis was uncommon in the tumors which were the origin from the palate and parotid, with incidence rates of 6.1% and 3.4%, respectively. Most AdCC cases (70.7%) showed the classic “tunnel-style” metastatic pattern of occurrence, and the level Ⅰ and Ⅱ regions were the most frequently involved areas. The 5-year and 10-year overall survival rates of the patients with lymph node metastasis were 77.4% and 20.6% respectively, while the 5-year and 10-year overall survival rates of the patients with no lymph node metastasis were 83.5% and 57.6%, respectively. The univariate analysis demonstrated that statistically significant differences in the overall survival for the presence of lymph node metastasis (P<0.001). In the meantime, the 5-year disease-free survival rate of the patients with lymph node metastasis also showed statistically significant differences to that of the AdCC patients with no lymph node metastasis. In addition, the primary site and histological grade were significantly associated with lymph node metastasis, and the high-grade solid growth pattern was identified as a strong predictor for the occurrence of lymph node metastasis. Conclusion: Cervical lymph node metastasis has a high tendency of occurrence in submandibular gland and tongue-mouth floor complex, and the high-grade solid growth pattern could be taken as a strong predictor for the occurrence of lymph node metastasis, which correlates to poor prognosis of AdCC patients. A selective neck dissection should be considered as a ma-nagement in such patients.

Key words: Salivary glands, Carcinoma, adenoid cystic, Lymph nodes, Metastasis, Pathology, clinical

中图分类号:

R739.87

张晔,张妮,刘晓筱,周传香. 唾液腺腺样囊性癌淋巴结转移相关的临床病理分析[J]. 北京大学学报（医学版）, 2020, 52(1): 30-34.

Ye ZHANG,Ni ZHANG,Xiao-xiao LIU,Chuan-xiang ZHOU. Cervical lymph node metastasis in adenoid cystic carcinoma of the salivary glands: A clinicopathologic study[J]. Journal of Peking University(Health Sciences), 2020, 52(1): 30-34.

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Characteristic	Lymph node status		P
Characteristic	Positive (+)	Negative (-)	P
Age			0.816
≤50 years old	41	344
>50 years old	41	372
Gender			0.409
Male	38	296
Female	44	420
Tumor size			0.345
≤3 cm	58	542
>3 cm	24	174
Perineural invasion			0.264
Yes	60	475
No	22	241
Tumor site			<0.001
Submandibular gland	25	95
Other sites	57	621
Histological grade			<0.001
Tubular-cribriform	37	622
Solid	45	94