唾液腺恶性肿瘤的治疗方法及进展

Therapeutic Methods and Research Progress of Malignant Salivary Gland Tumors

摘要: 唾液腺恶性肿瘤是头颈部少见恶性肿瘤，好发于中老年男性，发病特征及预后因组织学亚型差异显著，以黏液表皮样癌、腺样囊性癌最为多见，具有局部侵袭性强、易神经周围侵犯、复发及远处转移率高的特点。目前该病发病机制主要包括组织发生学说与形态发生学说两大主流理论；临床治疗以手术为首选，辅以放射治疗、化学治疗，手术包含口内入路、下颌骨切开入路及经口机器人手术等方式，调强放疗多用于术后高危患者辅助治疗，传统化疗整体客观缓解率偏低，仅适用于晚期复发转移病例。新兴治疗中，PD-1/PD-L1免疫治疗、HER2靶向治疗在特定亚型中展现出良好疗效，而c-KIT靶向治疗临床获益有限。当前临床仍存在早期诊断困难、复发转移防控不足、靶向免疫治疗存在耐药及适用人群受限等问题。未来需依托多组学技术挖掘分子标志物与治疗靶点，规范微创外科手术的应用标准，探索手术、放化疗与靶向免疫的联合综合治疗模式，推动唾液腺恶性肿瘤精准个体化诊疗发展。

Abstract: Malignant salivary gland tumors are rare malignancies of the head and neck, which predominantly affect middle-aged and elderly males. Their incidence characteristics and prognosis vary significantly among histological subtypes, with mucoepidermoid carcinoma and adenoid cystic carcinoma being the most common. These tumors are characterized by strong local invasiveness, frequent perineural invasion, high rates of local recurrence and distant metastasis. At present, the pathogenesis mainly includes two mainstream theories: histogenetic theory and morphogenetic theory. Surgery is the primary treatment modality, combined with radiotherapy and chemotherapy as adjuvant therapies. Common surgical approaches include intraoral approach, mandibulotomy approach and transoral robotic surgery. Intensity-modulated radiotherapy is mostly applied as adjuvant therapy for high-risk postoperative patients. Traditional chemotherapy shows a low overall objective response rate and is only suitable for advanced recurrent and metastatic cases. Among emerging therapies, PD-1/PD-L1 immunotherapy and HER2-targeted therapy have achieved satisfactory efficacy in specific subtypes, while c-KIT targeted therapy yields limited clinical benefits. At present, clinical challenges still exist, such as difficulty in early diagnosis, inadequate prevention and control of recurrence and metastasis, as well as drug resistance and limited applicable population of targeted and immunotherapy. In the future, multi-omics technology should be used to explore molecular biomarkers and therapeutic targets, standardize the application criteria of minimally invasive surgery, explore the combined comprehensive treatment model of surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy, so as to promote the development of precise and individualized diagnosis and treatment for malignant salivary gland tumors.