嗜神經侵襲與涎腺腺樣囊性癌臨床特征的相關性分析

[摘要] 目的 分析嗜神經侵襲（PNI）與涎腺腺樣囊性癌（SACC）臨床特征的相關性。 方法 回顧性分析1995年1月～2015年12月成都市第三人民醫院口腔科收治的SACC患者臨床資料，經篩選其中54例患者的各項臨床特征可能與PNI關系密切，應用Logistic回歸模型進行多因素分析。 結果 在54例SACC患者中，術前存在PNI的患者共有11例，其中8例發生在腭腺，2例在舌下腺，1例在腮腺。分析結果顯示，不同性別、年齡、臨床分期、腫瘤大小、淋巴結轉移患者PNI比較，差異無統計學意義（P > 0.05）；病變部位、病理類型、生物學指標PNI差異有統計學意義（P < 0.05）。術前出現PNI的患者，其術后復發率高于未出現者（P < 0.05），生存率低于未出現者（P < 0.05）。Logistic回歸結果顯示，PNI與腫瘤部位、病理類型、生物學指標密切相關（P < 0.05）。 結論 病變部位、病理類型及生物學指標均可作為判斷患者術前有無PNI的臨床依據。PNI作為SACC預后的一個獨立高危因素，可明顯增加腫瘤術后復發率，降低患者術后生存率，術前檢測患者有無PNI有助于評估腫瘤的預后。

[關鍵詞] 腺樣囊性癌；嗜神經侵襲；臨床特征

[中圖分類號] R739.87 [文獻標識碼] A [文章編號] 1673-7210（2017）11（c）-0118-04

Analysis of the relationship between perineural invasion and clinical features of salivary adenoid cystic carcinoma

CHEN Qi

Department of Stomatology， the Third People's Hospital of Chengdu， Sichuan Province， Chengdu 610031， China

[Abstract] Objective To analyze the relationship between perineural invasion （PNI） and clinical features of salivary adenoid cystic carcinoma （SACC）. Methods The clinical data of SACC patients treated in Stomatology Department of the Third People's Hospital of Chengdu from January 1995 to December 2015 were retrospectively analyzed. The clinical features of 54 cases potentially relevant to PNI were selected. Logistic model was used for multivariate factors analysis. Results Among 54 cases with SACC， there were 11 patients with PNI before operation， 8 cases in palatine gland， 2 cases in sublingual gland and 1 case in parotid gland. The results showed that there were no statistically significant differences in PNI among patients with different gender， ages， clinical stages， tumor sizes and lymphatic metastasis （P > 0.05）， but there were statistically significant differences in PNI among patients with different lesion location， pathological type and biological indicators （P < 0.05）. The postoperative recurrence rate of patients with PNI was higher than that of patients without PNI （P < 0.05）. Conversely， postoperative survival rate of patients with PNI was lower than that of patients without PNI （P < 0.05）. Logistic regression results showed that lesion location， pathological type and biological indicators were closely related with PNI （P < 0.05）. Conclusion Lesion location， pathological type and biological indicators can be used to determine whether patients have PNI or not before operation. PNI is an independent risk factor for prognosis of SACC， which can obviously increase the postoperative recurrence rate and reduce the postoperative survival rate. Preoperative examination of patients with PNI or not can be helpful for evaluation of the prognosis of the tumor.endprint

[Key words] Salivary adenoid cystic carcinoma； Perineural invasion； Clinical features

涎腺腺樣囊性癌（salivary adenoid cystic carcinoma，SACC）是頜面部較常見的惡性腫瘤，其生物學行為獨特，生長速度相對緩慢，但容易侵犯神經組織，出現嗜神經侵襲癥狀（perineural invasion，PNI）。癌變早期即發現有侵襲癥狀出現，沿神經組織轉移的腫瘤細胞可長期潛伏在轉移部位，手術治療不易徹底，而且對放療、化療不敏感，部分患者在治療后仍易出現復發癥狀，并擴散至鄰近組織及遠端器官[1-2]。目前尚無確切的理論解釋SACC的PNI生物學機制，更無針對性的治療措施。因此，分析與PNI相關的臨床特征，有助于制訂個體化的治療方案，為判斷疾病的預后情況提供參考。

1 資料與方法

1.1 一般資料

選擇1995年1月～2015年12月成都市第三人民醫院口腔科收治的SACC患者79例，對有明確隨訪結果的54例患者進行臨床特征與病理類型分析。納入標準：①均行手術治療并經病理檢查確診證實為SACC患者；②有……