国际口腔医学杂志

国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (4): 459-467.doi: 10.7518/gjkq.2021061

• 综述 • 上一篇    下一篇

唾液腺导管癌的诊疗研究进展

马平川(),李春洁,李龙江()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院头颈肿瘤外科 成都 610041
  • 收稿日期:2020-11-20 修回日期:2021-04-12 出版日期:2021-07-01 发布日期:2021-06-30
  • 通讯作者: 李龙江
  • 作者简介:马平川,学士,Email： mapingchuan1997@126.com
  • 基金资助:
    国家自然科学基金(81870782);四川省卫生健康委员会科研课题(18PJ094)

Diagnosis and treatment of salivary duct carcinoma

Ma Pingchuan(),Li Chunjie,Li Longjiang()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2020-11-20 Revised:2021-04-12 Online:2021-07-01 Published:2021-06-30
  • Contact: Longjiang Li
  • Supported by:
    National Natural Science Foundation of China(81870782);Scientific Research Project of Sichuan Provincial Health Commission(18PJ094)

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摘要：

唾液腺导管癌（SDC）是发生于人体唾液腺的一种少见的侵袭性较强的上皮源性恶性肿瘤,最常发生于腮腺,常用的影像学检查方法包括超声、CT以及磁共振成像,也可以使用正电子发射型计算机断层显像判断肿瘤的位置以及远处转移,利用针吸细胞学检查也可以辅助诊断。SDC的治疗目前最常采用手术治疗加术后辅助放射和化学治疗,大多数患者同时接受颈部淋巴结清扫术,但术后辅助性放射和化学治疗的效果目前仍存在争议。对于SDC的靶向治疗是目前研究的热点,包括作用靶点为雄激素受体的雄激素阻断治疗以及作用于人表皮生长因子受体-2的以曲妥珠单抗为基础的治疗。SDC预后极差,但该疾病的不良预后因素还存在争议。本文就SDC的诊断、治疗以及预后相关研究进展作一综述,以促进该疾病的认识、诊断与治疗的发展。

关键词: 唾液腺导管癌, 诊断, 靶向治疗, 预后

Abstract:

Salivary duct carcinoma (SDC) is a rare and aggressive epithelial malignant tumor that occurs in human salivary glands, of which the parotid gland accounts for the largest proportion. The imaging examination of SDC includes ultrasound, CT, and magnetic resonance imaging. Positron emission tomography-computed tomography can also be used to determine tumor location and distant metastases. In addition, fine-needle aspiration cytology can be used in diagnosis. For the treatment of SDC, the most common method is surgery with postoperative adjuvant radiotherapy and chemotherapy. Moreover, most patients undergo neck dissection. However, the effects of postoperative adjuvant chemoradiotherapy remain unclear. At present, targeted therapies for SDC are considered as research hotspots, including androgen deprivation therapy targeting androgen receptor and Trastuzumab-based treatment targeting human epidermal growth factor receptor-2. Meanwhile, SDC has a poor prognosis. However, the determination of the adverse prognostic factors of the disease remains controversial. This article will review the research advances in the diagnosis, treatment, and prognosis of SDC to improve understanding of the diagnosis and treatment of this disease.

Key words: salivary duct carcinoma, diagnose, targeted therapy, prognosis

中图分类号: 

  • R781.7

表 1

近年SDC靶向治疗的文献回顾"

作用
位点		 参考文献 研究类型 患者数 用药方案 作用效果 预后
AR [28] 病例报告 8 比卡鲁胺50 mg·d-1+曲普瑞林每28 d注射3.6 mg 2名CR、2名PR、3名SD、1名PD 总体反应率：64.7%;5年生存率：19.3%;3年PFS：11.8%
AR [29] 病例报告 10 7名：比卡鲁胺150 mg·d-1;2名：比卡鲁胺50 mg·d-1;1名：比卡鲁胺50 mg·d-1+戈舍瑞林每4周3.6 mg 2名PR、3名SD、5名PD 中位PFS：12个月
AR [30] 回顾性
队列研究		 实验组：22;
对照组：111		 比卡鲁胺150 mg·d-1+戈舍瑞林每3月10.8 mg或曲普瑞林每28 d 3.25 mg 无 3年DFS：48.2%（95% CI：14.0%~82.4%）
3年OS：77.9%（95% CI：49.7%~100%）
AR [31] 回顾性
队列研究		 实验组：34;
对照组：43		 比卡鲁胺150 mg·d-1或比卡鲁胺50 mg·d-1+戈舍瑞林每4周3.6 mg 6名PR、11名SD、17名PD 中位OS：17个月（95% CI：10~24月）
中位PFS：4个月（95% CI：3~5月）
AR [32] 病例报告 1 比卡鲁胺80 mg·d-1+亮丙瑞林每4周3.75 mg 原发肿瘤与肺部转移肿瘤均增大 无
HER-2 [33] 病例报告 2 多西他赛每3周静脉给药75 mg·m-2+曲妥珠单抗每3周皮下注射600 mg+帕妥珠单抗每3周皮下注射420 mg,其中第1周期帕妥珠单抗加载剂量840 mg 2名PR 无
HER-2 [34] 病例报告 3 曲妥珠单抗每3周静滴6 mg·kg-1为1周期（第1周期为8 mg·kg-1）+紫杉醇每周80 mg·m-2 3名PR 无
HER-2 [35] 病例报告 1 紫杉醇175 mg·m-2+卡铂（6 AUC）+曲妥珠单抗（6 mg·kg-1）每21 d 1名SD 无
HER-2 [36] 病例报告 13 3名：仅使用曲妥珠单抗（每周4 mg·kg-1或2 mg·kg-1）;8名：曲妥珠单抗（每周4 mg·kg-1或2 mg·kg-1）+化学治疗;2名：曲妥珠单抗仅作为辅助治疗的一部分 3名SD、2名PR、4名无反应、1名PD、3名无法评估 无
HER-2 [37] 病例报告 2 曲妥珠单抗每周2 mg·kg-1（加载剂量4 mg·kg-1）+紫杉醇每周80 mg·m-2 1名PR、1名PD 无
HER-2 [38] 临床2期实验 57 曲妥珠单抗每3周静滴6 mg·kg-1为1周期（第1周期为8 mg·kg-1）+多西他赛每3周70 mg·m-2 总有效率70.2%（95% CI：56.6%~81.6%）;临床收益率84.2%（95% CI：72.1%~92.5%） 中位PFS：8.9个月（95% CI：7.8~9.9月）;中位OS：39.7个月
HER-2 [39] 病例报告 5 卡铂（5~6 AUC）+紫杉醇（175 mg·m-2）+曲妥珠单抗（2 mg·kg-1） 1名CR、2名PR、2名PD 中位PFS：18个月
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