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Maligne epitheliale Speicheldrüsentumoren

Klinischer Rückblick über zwei Jahrzehnte

Malignant epithelial salivary gland tumors

Clinical review of 2 decades

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Zusammenfassung

Fragestellung

Ziel dieser Untersuchung war, unsere langjährigen Erfahrungen mit verschiedenen Tumorentitäten der Speicheldrüsenkarzinome zu analysieren.

Patienten

Retrospektiv wurden 155 Patienten mit Speicheldrüsenkarzinomen erfasst, welche zwischen Januar 1983 und Dezember 2002 in der Klinik für Mund-, Kiefer- und Gesichtschirurgie der Medizinischen Hochschule Hannover behandelt worden waren.

Ergebnisse

An adenoid-zystischen Karzinomen war 1,0% unserer Patienten erkrankt, 27,1% litten an Mukoepidermoidkarzinomen, 7,7% an Adenokarzinomen, 6,5% an polymorphen Adenokarzinomen und insgesamt 7,7% an weiteren Tumorentitäten mit geringeren Fallzahlen. Eine R0-Resektion wurde für 63,5% der Patienten mit hochmalignen Tumoren und für 80,0% der Patienten mit niedrigmalignen Tumoren erzielt. 26,2% der Patienten mit hochmalignen Tumoren und 13,3% der Patienten mit niedrigmalignen Tumoren erhielten eine postoperative Bestrahlung. Für das Gesamtkollektiv lagen die lokale Tumorkontrolle nach 5, 10 und 15 Jahren bei 77,5%, 66,2% und 59,0%, die regionale Tumorkontrolle nach 5, 10 und 15 Jahren bei 93,5%, 87,6% und 85,4%, die Fernmetastasenkontrolle nach 5, 10 und 15 Jahren bei 85,9%, 77,2% und 73,6% und die Überlebensrate nach 5, 10 und 15 Jahren bei 65,9%, 48,0% und 39,8%. Es gab einen signifikanten Unterschied zwischen niedrig- und hochmalignen Tumoren. Die beste Prognose zeigten polymorphe Adenokarzinome, gefolgt von niedrigmalignen Mukoepidermoidkarzinomen, adenoid-zystischen Karzinomen, Adenokarzinomen und hochmalignen Mukoepidermoidkarzinomen. Die Fallzahlen der übrigen Tumorentitäten waren zu gering, um eigene Untergruppen für statistische Auswertungen bilden zu können. Tumorentität, Tumorstadium und Resektionsstatus hatten einen signifikanten Einfluss auf die Prognose. Ein positiver Effekt für eine postoperative Bestrahlung konnte statistisch nicht nachgewiesen werden.

Schlussfolgerungen

Die Einteilung verschiedener Tumorentitäten nach ihrem Malignitätsgrad erweist sich aus prognostischer Sicht als sinnvoll, muss aber vor dem Hintergrund des Tumorstadiums betrachtet werden. Patienten mit Speicheldrüsenkarzinomen sollten zukünftig für prospektive randomisierte Studien multizentrisch erfasst werden, um die Wirksamkeit adjuvanter Behandlungsmodalitäten auch für seltene Tumorentitäten bestimmen zu können.

Abstract

Purpose

In this retrospective study we give a clinical review of our experience with different tumor entities of salivary gland cancer.

Patients

Between January 1983 and December 2002, a total of 155 patients with carcinomas of the salivary glands received initial treatment at the Department of Oral and Maxillofacial Surgery, Hanover Medical School.

Results

There were 51.0% adenoid cystic carcinomas, 27.1% mucoepidermoid carcinomas, 7.7% adenocarcinomas, 6.5% polymorphous adenocarcinomas, and altogether 7.7% other less frequent tumor entities. Complete resection was achieved for 63.5% of patients with high-grade carcinomas and for 80.0% of patients with low-grade carcinomas. Postoperative radiation was administered to 26.2% of patients with high-grade carcinomas and 13.3% of patients with low-grade carcinomas. Overall local control rates at 5, 10, and 15 years were 77.5%, 66.2%, and 59.0%. Overall regional control rates at 5, 10, and 15 years were 93.5%, 87.6%, and 85,4%. Overall distant control rates at 5, 10, and 15 years were 85.9%, 77,2%, and 73,6%. Overall survival rates at 5, 10, and 15 years were 65,9%, 48,0%, and 39,8%. There was a significant difference between patients with low-grade and high-grade carcinomas. Polymorphous adenocarcinomas showed the best prognosis, followed by low-grade mucoepidermoid carcinomas, adenoid cystic carcinomas, adenocarcinomas, and high-grade mucoepidermoid carcinomas. The number of the remaining tumor entities was too small to be divided into independent subgroups for statistical analysis. Tumor entity, tumor stage, and margin status significantly influenced prognosis. Statistically, we were not able to demonstrate a positive effect for postoperative radiation.

Conclusion

Grading is important, but should be considered in the context of stage. In the future, patients with salivary gland carcinomas should be randomized for prospective multicenter clinical trials, which could provide reliable information about adjuvant treatment modalities and their results even for rare subtypes of salivary gland cancer.

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Authors and Affiliations

  1. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover

    H. Kokemüller, N. Brüggemann, P. Brachvogel & A. Eckardt

  2. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover

    H. Kokemüller

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  1. H. Kokemüller
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  2. N. Brüggemann
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  3. P. Brachvogel
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  4. A. Eckardt
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Correspondence to H. Kokemüller.

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Kokemüller, H., Brüggemann, N., Brachvogel, P. et al. Maligne epitheliale Speicheldrüsentumoren. Mund Kiefer GesichtsChir 8, 191–201 (2004). https://doi.org/10.1007/s10006-004-0531-2

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