Revista do Colégio Brasileiro de Cirurgiões
versão impressa ISSN 0100-6991
LIMA, Roberto Araujo et al. Neck metastasis in malignant parotid tumors. Rev. Col. Bras. Cir. [online]. 2006, vol.33, n.3, pp. 132-139. ISSN 0100-6991. http://dx.doi.org/10.1590/S0100-69912006000300002.
BACKGROUND: Factors influencing the occurrence of neck metastasis and survival in patients with parotid malignant epithelial tumors are analyzed. METHODS: One hundred fifty patients treated at our institution from 1974 to 1998 were retrospectively reviewed. Twenty four patients were not treated by surgery and were excluded from this study. The remaining 126 patients were operated on and 74 patients had postoperative radiotherapy. Thirty four patients were treated with parotidectomy plus neck dissection. The mean age was 49 years old. According to the UICC/1997 TNM Classification 49 patients were Stage I, 27 were Stage II, 22 were Stage III, and 28 were Stage IV. The influence of selected factors on 10 years disease-specific survival was analyzed using Kaplan-Meier actuarial method and log-rank test. RESULTS: Forty patients had mucoepidermoid carcinoma, 18 patients adenocarcinoma, 18 patients acinic cell carcinoma, 15 patients adenoid cystic carcinoma, 11 patients carcinoma ex pleomorphic adenoma, 11 patients salivary duct carcinoma, and 13 patients other pathology. Recurrences occurred on 27 patients, 17 local, 4 had neck recurrences, and 4 loco-regional recurrences. Overall incidence of neck metastasis was 17.5%. Occult neck metastasis occurred in 5 patients who underwent elective neck dissection. Facial nerve dysfunction, age, T stage, grade, and histology were related to the recurrence of neck metastasis in univariate analysis. Prognoses were negatively influenced by five factors: T3- T4 stage, high malignancy grade, presence of cervical metastases, facial nerve palsy at first presentation and age higher then 50 years old. Ten years disease-specific survival was 97% for stage I, 81% for stage II, 56% for stage II, and 20% for stage IV. CONCLUSION: Tumor grade and stage were the most important prognostic factors. In spite of lack of prospective randomized published studies, recommendations to do elective neck dissections in high grade tumors, T3- T4 stage tumors, and facial nerve palsy at presentation should be considered.
Palavras-chave : Parotid gland; Lymphatic metastasis; Parotid neoplasms; Neck dissection; Prognosis.