[Analysis for therapy and prognosis of undifferentiated carcinoma with lymphoid stroma in salivary gland].
OBJECTIVE
To analyse the clinical characteristic, evolution and prognosis of undifferentiated carcinoma with lymphoid stroma(malignant lymphoepithelial lesions, MLEL) in salivary gland.


METHODS
During 1989 and 1997, 21 cases of MLEL in salivary gland were treated. The primary site was parotid in 18 cases, palate minor salivary gland in 2 cases and submandibular gland in 1 case. There were 5 men and 16 women with an age range of 31 to 74 years (median, 41 years). For stage II, III, mass dissection and superficial or total parotidectomy were adopted. The facial nerve was preserved when it had not been invaded. 3 to 25 lymph nodes were subjected to exam in pathology for every neck dissection specimen. For stage IV, neck dissection may be included, when necessary. All patients were irradiated on primary site or including ipsilateral neck 2 to 9 weeks after operation, except 2 cases irradiated after recurrence. Tumor doses were 52.03Gy in average.


RESULTS
There were 3/21 patients with recurrent benign lymphoepithelial lesion history (BLEL). The shortest duration from the recurrence to specific diagnosis was 6 months, and the longest was 2 years. The II, III, IV stage cases were 8(42.9%), 3 (14.3%), 10 (47.6%), respectively. All of II, III stage cases were N0. The cases with positive lymph nodes were 10/21(47.61%). The 5-year survival rate was 70.66%, for II, III, IV stage was 86.68%, 66.67%, 33.3%, respectively, analyzed by Life Table. And test with Wilcoxon (Gehan) statistic, P=0.2789, means there was no specific difference among each group. In the group, 5 patients dead and 2 lost follow up (counted in dead); mortality was 33.31%, all of them were IV stage. Superior and middle deep cervical metastasis were found in 4 of those patients with parotid MLEL, and neck dissection and ipsilateral neck irradiation were adopted. Recurrence was found in 7/21(33.3%), 5 of 7 cases were IV with N2 or N3, 2 of 7 were palate MELE in early or middle stage. There were 6/7 recurrence occurred on neck. The duration from first treatment to recurrence was 20.7m in median, the shortest was 5 months and the longest was 65 months, among them the recurrence occurred shorter than 20 months in 5 cases. After comprehensive treatment, 3 patients were alive and 3 cases dead. Metastasis occurred in 4 patients in IV stage (T4N2M0), with positive middle cervical lymph nodes in 3 cases treated by neck dissection before.


CONCLUSIONS
Recurrent BLEL intends to develop to malignant lesion. Superior and middle deep cervical lymph nodes metastasis were not unusual in IV stage patients. Neck, dissection and irradiation should be carried out on these patients, especially for those with N2. The peak time of recurrence was 2 years after the first treatment, and during the time, the tumor proliferated rapidly. Active comprehensive treatment should be carried out on recurrent patients. For patients with positive middle deep cervical lymph nodes, chemotherapy or other methods should be adopted to prevent distant metastasis.
Cai
Yi-li
YL
Radiotherapy Division, Department of Oral and Maxillofacial Surgery, School of Stomatology, Ninth People's Hospital, Shanghai Second Medical University, Shanghai 200011, China. cy4806@guomai.sh.cn
Wang
Zhong-he
ZH
Lu
Shun-juan
SJ