目的：探讨唾液腺癌经手术联合125I粒子治疗后远处转移的一般规律及影响远处转移的临床病理因素。方法：选取2001年10月至2010年3月就诊于北京大学口腔医院经手术联合125I粒子治疗的唾液腺癌患者197例，总结远处转移的发生特点，应用单因素和多因素方法分析影响远处转移的临床病理因素。结果：远处转移率为14.2%（28/197），常见部位是肺（25/28，89.3%），其次是骨（5/28,17.9%）和肝（4/28,14.3%）；诊断至远处转移的时间为5~168个月，平均时间（44.2±45.8）个月，中位时间64个月；远处转移至死亡的时间为0~54个月，平均时间（9.7±13.4）个月，中位时间12个月。3年局部区域控制率和生存率分别为90.8%，87.8%；5年分别为84.0%，81.0%。单因素分析局部区域控制情况（F=26.997，P <0.01）和组织学分型（F=1.592，P<0.01）是唾液腺癌远处转移的危险因素；而性别、年龄、原发部位、T分期、术后淋巴结是否阳性、肿瘤切缘及面神经侵犯情况，与唾液腺癌远处转移无显著关系；多因素分析局部区域控制情况（F=29.332，P<0.01）是影响唾液腺癌远处转移的主要因素。结论：手术联合125I粒子治疗唾液腺癌，局部控制率高，延长远处转移的发生时间，局部区域控制情况是影响唾液腺癌远处转移的主要因素。
Objective：To investigate clinical features of distant metastases (DM)and analyze clinicopathologic risk factors associated with DM from salivary gland carcinomas after being treated by surgery combined with 125I internal brachytherapy. Methods: Between October 2001 and March 2010, 197 patients with salivary gland carcinoma were treated by surgery combined with 125I internal brachytherapy and had follow-up for 2 years or more. Univariate and multivariate analyses were performed to evaluate clinicopathologic risk factors that might influence the risk of distant metastases.Results: DM occurred in 28 of 197 patients (14.2%). The commonest site of distant metastases overall was the lung 89.3% (25/28), followed by bones 17.9% (5/28) and liver (4/28). DM developed after an average interval of (44.2±45.8) months from the time of initial diagnosis, and the mean interval was 64 months. The average time to death after the diagnosis of DM was only (9.7±13.4) months, and the mean time was 12 months. The 3-year locoregional control rate and survival rate were 90.8%, and 87.8% respectively，and the 5-year ones 84.0% and 81.0%, respectively. Univariate analyses revealed that the risk of distant metastases was significantly influenced by locoregional tumor failure (F=26.997，P<0.01) and histologic differentiation (F=1.592，P<0.01). Multivariate analysis of freedom from distant metastases revealed that locoregional control (F=29.332，P<0.01) significantly influenced this end point. Conclusion: Salivary gland carcinoma could achieve high local control rate after being treated by surgery combined with 125I internal brachytherapy, and the average interval from diagnosis to DM was prolonged, DM was significantly influenced bylocoregional control.
