Clinical Analysis Of Salivary Adenoid Cystic Carcinom In 59patients

ObjectiveTo study the relevant factors of local recurrence, distant metastases and survival rate of patients who suffer from Adenoid Cystic Carcinoma(ACC),in order to improve the survival rate, decrease the local recurrence rate and distant metastasis rate of patients after operation, and to provide a more powerful basis for clinical treatment of ACC.Materials and methodsRetrospectively reviewed 59 patients who were diagnosed with ACC and treated with surgery in the Department of Stomatology in First Affiliaetd Hospital of Dalian Medical University between March 2003 and August 2014, and obtained clinical data of 0.5 ~12years, and all the clinical data of patients are complete and confirmed as ACC after pathological examination.To analyze the relationship of the relevant factors,such as the gender, age, location of the lesion, TNM staging, pathological type, perineural invasion, treatment methods, local recurrence, distant metastases and survival rate,we use the univariate to select out the significantly relevant factors of local recurrence and distant metastasis,and then adopt them to the multivariate logistic regression model to pick up the significantly relevant multi-factors of local recurrence and distant metastasis.Adopt Kaplan-Meier to test the survival rate for 1 year,3 years,5 years and 10 years,and analyze the relevant factors of survival rate after operation by univarite,and then test the significantly relevant factors of survival rate by log-rank,finally use Cox’sproportional hazards regression model to analyze the significantly relevant factors of survival rate after operation.Results1. In 59 cases of ACC patients,the proportion of male and female is 1:1.5.Age of onset is concentrate on 45~59 years old,which is the 39.0% of all the 59 patients.46 cases of ACC are coming from the major salivary gland,with parotid gland for a maximum of 24 cases,and 13 cases of ACC are coming fron the minor salivary gland.Based on TNM clinical stage,there are 31 cases of the early stage(Ⅰ+Ⅱ)and29cases of the late stage(Ⅲ+Ⅳ).According to the pathological type,there are 42 cases of adenoid/tubular and 17 cases of solid.According to the treatment method,29 patients undergo the operative treatment and 30 patients undergo the operative treatment with radiotherapy and chemotherapy after operation.According to the perineural invasion,25 cases are positive and 34 cases are negative.Besides,there are 35 cases of local recurrence after operation that is the 59.3% of all the 59 patients and 24 cases of the distant metastasis cases that is the 40.7% of all the 59 patients.Among the distant metastasis cases,there are 13 pulmonary metastasis,2 pulmonary metastasis with lymphatic metastasis,1 pulmonary metastasis with bone,brain metastasis,1 pulmonary metastasis with hepatic metastasis,1 brain metastasisand 6lymphatic metastasis.16 patients were dead after operation,27.1% of all the 59 patients,which 3 dead patients caused by local recurrence,11 dead patients caused by distant metastasis and the last 2dead patients by other reasons(not ACC).2.Local recurrence and distant metastasis:Univariate analysis results showed that the TNM clinical stage, pathological type and treatment methods were the important factors of the local recurrence,TNM clinical stage,pathological type and perineural invasion were the important factors of the distant metastasis.Through the logistic regression model for multivariate analysis,the results showed that pathological type and treated methods were the important factors of the local recurrence,TNM clinical stage and perineural invasion were the important factors of the distant metastasis.3.Survival rate:The survival rate of 59 cases of ACC patients for 1 year,3 years,5years,10 years is 100.0%,92.5%,88.0% and 54.5% respectively.Univariate analysis results showed that the TNM clinical stage,perineural invasion, pathological type and distant metastasis were the important factors of the survival rate.Adopting the four factors to the Cox’s proportional hazards regression model for multivariate analysis,the results showed that perineural invasion, pathological type and distant metastasis were important factors for the survival rate of ACC patients after operation.Conclusion1.Treatment method has a certain clinical significance for decreasing the local recurrence rate of ACC patients after operation.2.TNM clinical stage and pathological type were the main factors that influence the distant metastasis rate.3.The early prognosis is good for the patients,andlate is bad for the patients.4.Perineural invasion, pathological type and distant metastasis were the important factors that influence the survival rate of ACC patients after operation.