Background: Salivary duct carcinomas (SDC) are a rare and aggressive subtype of salivary gland neoplasm. They can present with distinct immunoprofiles, such as androgen receptor (AR) and HER-2/Neu-positivity. To date, no consensus exists on how to best manage this entity. Methods: All patients diagnosed with nonmetastatic AR+ SDC of the parotid from 2013 to 2019 treated with curative intent were included. Immunologic tumor profiling was conducted using 24 distinct markers. Kaplan–Meier analyses were used to estimate locoregional recurrence (LRR), distant control, and overall survival (OS). Results: Fifteen patients were included. Nine (60%) patients presented with T4 disease and eight (53%) had positive ipsilateral cervical lymphadenopathy. Ten (67%) patients underwent trimodality therapy, including surgery followed by adjuvant radiation and concurrent systemic therapy. The median follow-up was 5.5 years (interquartile range, 4.8–6.1). The estimated 5-year rates of LRR, distant progression, and OS were 6%, 13%, and 87%, respectively. Conclusion: Despite only including AR+ SDC of the parotid, immunoprofiles, such as expression of HER-2, were highly variable, highlighting the potential to tailor systemic regimens based on individual histologic profiles in the future. Studies with larger patient numbers using tumor-specific molecular profiling and tumor heterogeneity analyses are justified to better understand the biology of these tumors. Molecularly informed treatment approaches, including the potential use of AR- and HER-2/Neu-directed therapies upfront in the definitive setting, may hold future promise to further improve outcomes for these patients.
背景：涎腺导管癌（SDC）是一种罕见且侵袭性强的涎腺肿瘤亚型。其免疫表型特征多样，例如可表现为雄激素受体（AR）阳性和HER-2/Neu阳性。迄今为止，关于如何最佳治疗此类疾病尚未达成共识。方法：本研究纳入2013年至2019年间诊断为非转移性AR阳性腮腺SDC并接受根治性治疗的所有患者。采用24种特异性标志物进行免疫肿瘤谱分析。通过Kaplan-Meier法评估局部区域复发率（LRR）、远处控制率和总生存期（OS）。结果：共纳入15例患者。其中9例（60%）为T4期病变，8例（53%）伴有同侧颈部淋巴结转移。10例（67%）患者接受三联疗法，包括手术及术后辅助放疗联合同步全身治疗。中位随访时间为5.5年（四分位距4.8-6.1年）。预估5年LRR、远处进展率和OS分别为6%、13%和87%。结论：尽管仅纳入腮腺AR阳性SDC病例，但HER-2表达等免疫表型存在显著异质性，提示未来基于个体组织学特征定制全身治疗方案的可能性。有必要开展更大样本量的肿瘤特异性分子谱分析和肿瘤异质性研究，以深入理解此类肿瘤的生物学特性。基于分子特征的治疗策略，包括在根治性治疗中早期应用AR靶向和HER-2/Neu靶向疗法，有望为改善患者预后提供新的方向。
肿瘤(癌症)患者之家