RESUMEN
OBJECTIVE: To analyze the factors in parotid malignant epithelial tumors influencing recurrences and disease-specific survival. METHODS: We retrospectively reviewed the files of 150 patients treated at our institution, from 1974 to 1998. Twenty-four patients were not treated by surgery and were excluded from this study. The remaining 126 patients were treated with surgery and 74 patients had postoperative radiotherapy. Thirty-three patients were treated with parotidectomy plus neck dissection. Neck lymph node metastasis was found in 22 patients, 5 patients had occult neck metastasis, and 4 periparotid lymph nodes metastasis. The mean age was 49 years old. According to the UICC/1997 TNM Classification, 49 patients were stage I, 27 stage II, 22 stage III, and 28 stage IV. The influence of selected factors on the 10 year disease-specific survival was analyzed using the Kaplan-Meier actuarial method and the log-rank test. RESULTS: Forty patients had mucoepidermoid carcinoma, 18 patients adenocarcinoma NOS, 18 patients acinic cell carcinoma, 15 patients adenoid cystic carcinoma, 11 patients malignant mixed tumor, 11 patients salivary duct carcinoma, and 13 patients other pathology. Twenty-five patients had recurrences: 17 had local recurrences, 4 patients had neck recurrences, and 4 were loco-regional recurrences. Five factors influenced negatively the prognosis: 1) T stage (p.00001), 2) grade (p.00001), 3) + lymph nodes (p.0007), 4) facial nerve dysfunction (p.0001), and 5) age (p.004). Patients with high-grade tumors and high-stage tumors had the worst prognosis according to the multivariate analysis. The 10-year disease-specific survival was 97% for stage I, 81% for stage II, 56% for stage III, and 20% for stage IV. CONCLUSION: The grade of the tumor and stage were the most important prognostic factor. EBM RATING: C.
Asunto(s)
Adenocarcinoma/mortalidad , Adenocarcinoma/terapia , Invasividad Neoplásica/patología , Neoplasias de la Parótida/mortalidad , Neoplasias de la Parótida/terapia , Adenocarcinoma/patología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Disección del Cuello/métodos , Estadificación de Neoplasias , Glándula Parótida/efectos de la radiación , Glándula Parótida/cirugía , Neoplasias de la Parótida/patología , Probabilidad , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
O sarcoma sinovial é uma neoplasia maligna de partes moles que ocorre com mais freqüência em adultos jovens,localizando-se nas extremidades, próximo às grandes articulações. Sarcomas primários do pulmão são extremamente raros. Entre os tipos mais comuns que ocorrem nesta localização estão o leiomiossarcoma, fibrossarcoma e o hemangiopericitoma. O diagnóstico do sarcoma sinovial é dificultado justamente por essa baixa ocorrência e devido à semelhança de achados histológicos e morfológicos entre lesões primárias e metastáticas. A pesquisa citogenética da translocação t(x;18) (p11;q11) tem um papel mais importante nos casos de tumores monofásicos devido ao seu padrão de crescimento semelhante a de outros sarcomas assim como a análise imunohistoquimica e de ultraestrutura que também são exames que auxiliam o diagnóstico. Relatamos o caso de um sarcoma sinovial bifásico, primário de pulmão confirmado por análise imuno-histoquímica compatível com padrões descritos em literatura e que foi abordado com cirurgia, radioterapia conformacional e quimioterapia, evoluindo ao óbito, com doença local e à distância.