Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland

World Journal of Surgical Oncology

Jianlin Lou²  Zhong Liang²  Kejing Wang²  Liang Guo²  Chang Yu¹  Jiafeng Wang²  Jianqiang Zhao² 

[1] Department of Pathology, Zhejiang Cancer Hospital, Zhejiang 310022, China;Department of Head and Neck Surgery, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou, Zhejiang 310022, China

关键词: Survival;    Pleomorphic carcinoma;    Salivary gland;    Prognosis;    Carcinoma ex pleomorphic adenoma;   

Others  :  823527
DOI  :  10.1186/1477-7819-11-180

 received in 2013-03-20, accepted in 2013-07-27,  发布年份 2013

【 摘 要 】

Background

Carcinoma ex pleomorphic adenoma (CXPA) is an uncommon malignant tumor with highly aggressive biological behavior. Our goal was to investigate the prognosis of CXPA in the major salivary glands and factors influencing it.

Methods

We retrospectively reviewed 51 patients diagnosed with CXPA of the major salivary glands between 1999 and 2006, comprising 36 males and 15 females, aged from 23 to 86 years. All patients underwent surgery with curative intention, and 21 received postoperative radiation therapy.

Results

Of the 51 patients, 39.2% developed locoregional recurrence and 27.5% developed distant metastases. Median follow-up was 54 months. At the time of analysis, 29 (56.9%) patients were deceased. Overall survival was 62.7% at 3 years and 50.3% at 5 years. Tumor-specific survival was 64.4% at 3 years and 53.5% at 5 years. Using chi-squared tests, invasiveness, T stage, lymph node involvement and clinical stage were found to be significantly associated with locoregional recurrence. Histological grade, invasiveness, lymph node involvement and perineural invasion were associated with distant metastases (P < 0.05). Cox analysis showed that T stage, lymph node involvement, histological grade and perineural invasion were independent prognostic factors for overall survival.

Conclusion

T stage, lymph node involvement, histological grade, perineural invasion and extent of invasion are important prognostic factors of CXPA in the major salivary glands. Surgery is the primary treatment modality for CXPA and postoperative radiation therapy may be used in patients with factors for poor prognosis.

【 授权许可】

   
2013 Zhao et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Thompson L: World Health Organization classification of tumours: pathology and genetics of head and neck tumours. Ear Nose Throat J 2006, 85:74.
• [2]Gnepp DR: Malignant mixed tumors of the salivary glands: a review. Pathol Annu 1993, 28(Pt 1):279-328.
• [3]Antony J, Gopalan V, Smith RA, Lam AK: Carcinoma ex pleomorphic adenoma: a comprehensive review of clinical, pathological and molecular data. Head Neck Pathol 2012, 6:1-9.
• [4]Wahlberg P, Anderson H, Biorklund A, Moller T, Perfekt R: Carcinoma of the parotid and submandibular glands – a study of survival in 2465 patients. Oral Oncol 2002, 38:706-713.
• [5]Zbaren P, Zbaren S, Caversaccio MD, Stauffer E: Carcinoma ex pleomorphic adenoma: diagnostic difficulty and outcome. Otolaryngol Head Neck Surg 2008, 138:601-605.
• [6]Lewis JE, Olsen KD, Sebo TJ: Carcinoma ex pleomorphic adenoma: pathologic analysis of 73 cases. Hum Pathol 2001, 32:596-604.
• [7]Lüers JC, Wittekindt C, Streppel M, Guntinas-Lichius O: Carcinoma ex pleomorphic adenoma of the parotid gland. Study and implications for diagnostics and therapy. Acta Oncol 2009, 48:132-136.
• [8]Olsen KD, Lewis JE: Carcinoma ex pleomorphic adenoma: a clinicopathologic review. Head Neck 2001, 23:705-712.
• [9]Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L: Major and minor salivary gland tumors. Crit Rev Oncol Hematol 2010, 74:134-148.
• [10]Chandana SR, Conley BA: Salivary gland cancers: current treatments, molecular characteristics and new therapies. Expert Rev Anticancer Ther 2008, 8:645-652.
• [11]Katabi N, Gomez D, Klimstra DS, Carlson DL, Lee N, Ghossein R: Prognostic factors of recurrence in salivary carcinoma ex pleomorphic adenoma, with emphasis on the carcinoma histologic subtype: a clinicopathologic study of 43 cases. Hum Pathol 2010, 41:927-934.
• [12]LiVolsi VA, Perzin KH: Malignant mixed tumors arising in salivary glands. I. Carcinomas arising in benign mixed tumors: a clinicopathologic study. Cancer 1977, 39:2209-2230.
• [13]Chen AM, Garcia J, Bucci MK, Quivey JM, Eisele DW: The role of postoperative radiation therapy in carcinoma ex pleomorphic adenoma of the parotid gland. Int J Radiat Oncol Biol Phys 2007, 67:138-143.
• [14]Brandwein M, Huvos AG, Dardick I, Thomas MJ, Theise ND: Noninvasive and minimally invasive carcinoma ex mixed tumor: a clinicopathologic and ploidy study of 12 patients with major salivary tumors of low (or no?) malignant potential. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996, 81:655-664.
• [15]Tortoledo ME, Luna MA, Batsakis JG: Carcinomas ex pleomorphic adenoma and malignant mixed tumors. Histomorphologic indexes. Arch Otolaryngol 1984, 110:172-176.