D.Q. Ma

Factors influencing survival rate in adenoid cystic carcinoma of the salivary glands

OBJECTIVE To study factors influencing survival rate of adenoid cystic carcinoma (ACC) of the salivary glands. METHODS One hundred and twelve cases were followed up for move than ten years and were studied to investigate factors influencing the survival rate of patients. Statistical analysis was performed using a computer program (Survcalc, John Wiley Co.). The data were statistically treated for survival curves according to the kaplan-meier method. The log rank tests were employed to assess the statistical significance of various groups. RESULTS The age of the patients younger than 50 years old, early clinical stage, glandular/tubular histological type and tumor without nerve involvement had the best prognosis. Age of the patients older than 50 years old, ACC in the submandibular gland, advanced clinical stage (stage III and IV), solid histological type and tumor with nerve involvement had a poor prognosis. CONCLUSIONS Age of the patients, tumour site, clinical stage, histological type and with or without nerve involvement are the important factors influencing the prognosis.

Hand grip strength: an indicator of nutritional state and the mix of postoperative complications in patients with oral and maxillofacial cancers.

The aim of the study was to assess the reliability of hand grip strength as an indicator of nutritional state, and to see if it was of any value in the prediction of postoperative complications. One-hundred and twenty-seven patients who presented with oral and maxillofacial cancer were studied for measurement of hand grip strength, mid-arm muscle circumference, and creatinine-height index. Hand grip strength correlated well with mid-arm muscle circumference and creatinine-height index. Patients whose hand grip strength was < 85% of the control value developed significantly more postoperative complications than those in whom it was 85% or more (15/31 (48%) compared with 12/65 (18%), P = 0.004). In conclusion, hand grip strength is not only a useful, non-invasive indicator of skeletal muscle mass, but may also be of use in predicting postoperative complications.

Local excision of the parotid gland in the treatment of Warthin's tumour

The results of local excision of Warthins tumour in the parotid gland (n = 61) (resection of the tumour together with surrounding normal gland and associated lymph nodes) were compared with those of superficial parotidectomy (n = 88) for incidence of recurrence, duration of operation, and degree of facial deformity. A subgroup of patients in each group were tested for gustatory sweating (iodine starch test) and parotid function (quantitative scintigraphy). Local excision had the following advantages over superficial parotidectomy: shorter operating time, less risk of facial nerve damage, less facial deformity, lower incidence of Freys syndrome, and better preservation of the function of the parotid gland.

Clinicopathological study of distant metastases of salivary adenoid cystic carcinoma.

Most studies of the clinicopathological characteristics and prognosis of patients with distant metastasis of salivary adenoid cystic carcinoma (SACC) have used small patient samples. To further explore this issue, a descriptive and prognostic study of 467 patients with SACC who were treated from 1963 to 2009 was conducted at a single institution. One hundred and forty-five patients (31.0%) had distant metastases. At least 20% of patients who presented with the early-stage disease and no recurrence developed distant metastasis. The overall 5-, 10-, and 20-year survival rates were 85.6%, 67.4%, and 50.4%, respectively, for patients without distant metastasis, and 69.1%, 45.7%, and 14.3%, respectively, for patients with distant metastasis. The median survival time after distant metastasis was 36 months (range 1-112 months). The prognosis was similar between patients who received treatment for metastasis and those who did not. Patients who were diagnosed with early-stage disease and without local recurrence of the primary tumours could also develop distant metastases. The biological characteristics of adenoid cystic carcinoma were different from those of squamous cell carcinoma. At present, the effectiveness of treatment for distant metastases is not ideal and further research is needed.

Applicability of the general nutritional status score to patients with oral and maxillofacial malignancies

The general nutritional status (GNS) score was used to assess the nutritional status of 127 consecutive patients with oral and maxillofacial malignancies. Forty-six of our patients (36.2%) were undernourished (group 2), while 81 (63.8%) were in good nutritional condition (group 1). Comparison of nutritional laboratory tests between these two groups showed that the differences in serum albumin, transferrin, and creatinine-height index (CHI) had statistical significance, yielding an excellent correlation between the GNS score and the nutritional laboratory test. Undernourished patients had a significantly higher postoperative complication incidence (48.3%) than well-nourished patients (19.4%) (chi 2 = 6.637; P < 0.01), indicating that the GNS score can be used as a prognostic index.

Conservation of salivary secretion and facial nerve function in partial superficial parotidectomy.

Conventional total superficial parotidectomy (TP) has commonly been used, but partial superficial parotidectomy (PP) offers the possibility of better preserving glandular function and avoiding palsy of the facial nerves. In this study, the extent to which saliva secretion and facial nerve function were conserved in patients who received TP vs. PP was compared. Data were collected from patients who received a PP (n=163) or a TP (n=105) for benign primary tumours in the superficial lobe of the parotid glands between 1995 and 2009 at a single hospital. The incidence of transient facial paralysis was significantly lower in patients who received PP than in those who received TP. Secretory function was preserved for patients with a conserved Stensens duct, whereas patients in whom the duct had been ligated lost secretory function. Partial superficial parotidectomy reduces the incidence of postoperative facial nerve dysfunction and is conducive to preserving Stensens duct and saliva secretion.

Salivary gland tumours in a northern Chinese population: a 50-year retrospective study of 7190 cases

The aims of this study were to investigate the epidemiological and clinical characteristics of epithelial salivary gland tumours in a northern Chinese population and to evaluate the current TNM classification system. A demographic and descriptive analysis of 7190 epithelial salivary gland tumours was performed. There were 4654 benign tumours and 2536 malignant tumours. The percentage of tumours located in the parotid, submandibular, sublingual, and minor salivary glands was 62.66%, 9.92%, 2.57%, and 24.85%, respectively; 22.26%, 35.76%, 92.97%, and 61.89% of the tumours, respectively, were malignant. Over 90% in the tongue and maxillary sinus were malignant. Warthin tumour, salivary duct carcinoma, and squamous cell carcinoma were predominant in males, while basal cell adenoma, myoepithelioma, and pleomorphic adenoma were predominant in females. Further, 2.55% of the tumours were in children and adolescents: 44.81% of the tumours were malignant, as opposed to 35.02% in adults. According to the 7th TNM classification, the percentages of T3 and stage III tumours were approximately 10%. Salivary gland tumours show distribution patterns according to histological type, location, and patient age and sex. The limitations of the current TNM classification of salivary gland carcinoma should be considered and revisions made.

Comparison of the efficacy of different treatment modalities for Kimura's disease

The objective of this study was to investigate the clinical features of Kimuras disease in the head and neck region and to compare the local recurrence rate between three therapies used for the treatment of this disease. The clinicopathological information of 46 hospitalized patients suffering from Kimuras disease in the head and neck region over a 10-year period was reviewed retrospectively. All lesions were clinically observed in the head and neck region. These 46 patients underwent a total of 58 treatments; nine patients underwent multiple treatments due to local recurrence. Of the 58 treatments, 32 involved surgical excision alone, 24 involved surgical excision and postoperative low-dose radiotherapy (20-40Gy), one was a combination of ultrasound-guided core needle biopsy and radiotherapy, and one was a combination of incisional biopsy and subsequent radiotherapy. During the follow-up period, nine patients suffered 16 local recurrences. The recurrence rate of surgical excision combined with low-dose radiotherapy was much lower than that of surgical excision alone or radiotherapy alone (both P<0.05). It is concluded that Kimuras disease is a benign condition with a good prognosis, and surgical excision combined with postoperative low-dose radiotherapy is associated with the lowest local recurrence rate in the treatment of this disease.