CAJ | 학술논문

目的：：探讨唾液腺癌经手术联合125 I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125 I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125 I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。
목적：：탐토타액선암경수술연합125 I입자치료후원처전이적일반규률급영향원처전이적림상병리인소。방법：선취2001년10월지2010년3월취진우북경대학구강의원경수술연합125 I입자치료적타액선암환자197례,총결원처전이적발생특점,응용단인소화다인소방법분석영향원처전이적림상병리인소。결과：원처전이솔위14.2%(28/197),상견부위시폐(25/28,89.3%),기차시골(5/28,17.9%)화간(4/28,14.3%)；진단지원처전이적시간위5~168개월,평균시간(44.2±45.8)개월,중위시간64개월；원처전이지사망적시간위0~54개월,평균시간(9.7±13.4)개월,중위시간12개월。3년국부구역공제솔화생존솔분별위90.8%,87.8%；5년분별위84.0%,81.0%。단인소분석국부구역공제정황(F=26.997,P <0.01)화조직학분형(F=1.592,P<0.01)시타액선암원처전이적위험인소；이성별、년령、원발부위、T분기、술후림파결시부양성、종류절연급면신경침범정황,여타액선암원처전이무현저관계；다인소분석국부구역공제정황(F=29.332,P<0.01)시영향타액선암원처전이적주요인소。결론：수술연합125 I입자치료타액선암,국부공제솔고,연장원처전이적발생시간,국부구역공제정황시영향타액선암원처전이적주요인소。
Objective:To investigate clinical features of distant metastases ( DM ) and analyze clinico-pathologic risk factors associated with DM from salivary gland carcinomas after being treated by surgery combined with 125 I internal brachytherapy. Methods: Between October 2001 and March 2010, 197 pa-tients with salivary gland carcinoma were treated by surgery combined with 125 I internal brachytherapy and had follow-up for 2 years or more. Univariate and multivariate analyses were performed to evaluate clini-copathologic 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 metasta-ses was significantly influenced by locoregional tumor failure (F=26. 997,P<0. 01) and histologic dif-ferentiation (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: Sali-vary gland carcinoma could achieve high local control rate after being treated by surgery combined with 125 I internal brachytherapy, and the average interval from diagnosis to DM was prolonged, DM was signifi-cantly influenced bylocoregional control.