Management of clinically negative neck in salivary gland cancers – elective neck dissection, irradiation, or surveillance?

Szewczyk, Mateusz; Golusiński, Paweł; Pazdrowski, Jakub; Pieńkowski, Piotr

doi:10.5114/wo.2019.89245

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Our review and meta‐analysis were not able to determine which of END, ENI or observation is the best option in terms of LRC and therefore prognostically. In fact, in the literature, we have found only one study that compared these three modalities, with a cumulative analysis on all salivary gland tumours with non‐extractable parotid data 14 . However, this statistical analysis determined a pooled rate of occult lymph node metastases in cN0 parotid carcinomas of 0.22 (99% CI: 0.14‐0.30); this finding represents a significant percentage value, and underlines the need for further research to identify the most appropriate neck treatment in these patients.…”

Section: Discussionmentioning

confidence: 99%

Elective neck dissection in primary parotid carcinomas: A systematic review and meta‐analysis

Borsetto

Iocca

Boscolo‐Rizzo

et al. 2020

J Oral Pathology Medicine

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Background To estimate the rate of occult cervical lymph node metastases in cN0 patients affected by primary parotid carcinomas and to scrutinize the evidence on the indication and extent of elective neck dissection in these neoplasms. Methods Medline, Embase, Web of Science, Cochrane Library and Scopus were searched until August 31, 2020, to identify studies reporting the use of elective neck dissection in the management of malignant parotid tumours. The PRISMA checklist was used. A single arm meta‐analysis was then made to determine the pooled rate of occult lymph node metastases. Risk of bias of the included studies was assessed through the ROBINS‐E tool. Results The initial search returned 20 541 articles, of which twelve met the inclusion criteria and were included in the meta‐analysis. They comprised 1310 patients with parotid carcinoma, of whom 542 cN0 underwent elective neck dissection, which led to the diagnosis of lymph node metastasis (pN+/cN0) in 113 cases. Meta‐analysis of the results of elective neck dissection showed an overall rate of occult metastases of 0.22 (99% CI: 0.14‐0.30). Locally advanced or high‐grade tumours were the commonest indications for elective neck dissection in the included studies. The most dissected lymph node levels were I‐II‐III, and level II was the commonest site of occult nodal metastases. Conclusions An occult metastasis rate of 0.22 (99% CI: 0.14‐0.30) represents a not negligible percentage value, which should encourage further research to outline the most appropriate elective neck management in cN0 patients with parotid carcinomas.

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Section: Discussionmentioning

confidence: 99%

Elective neck dissection in primary parotid carcinomas: A systematic review and meta‐analysis

Borsetto

Iocca

Boscolo‐Rizzo

et al. 2020

J Oral Pathology Medicine

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“…(17%) had single nodes [5], A prognostic implication of as 22 dissected lymph nodes/, >20 dissected lymph nodes were previously described as minimizing the prohibition of resting occult metastases [9]. A total of eight pathologically positive lymph nodes were detected in 3 patients in the END group, [28]. In our series the median number of lymph nodes removed from the cervical neck was 29(range, 23-41 lymph nodes)., Pathologically positive lymph node 4 (range: 1-8 Nodes) and LN percent positive14.3 (range: 3.03-28.57).…”

Section: Cancer Therapy and Oncology International Journalmentioning

confidence: 59%

Management of Positive Cervical Lymph Nodes in Parotid Cancer

Zedan¹,

Aieat²,

Osama³

et al. 2021

CTOIJ

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Objective: Assessment the management of positive cervical lymph nodes in parotid cancer. Associated clinical symptoms, histological types, regional lymph node stage (n stage), occult metastasis, neck dissection by level, recurrence, neck irradiation. Methods. We carried out a retrospective analysis of 43 patient’s pathological positive lymph nodes metastatic from parodied cancer, who underwent neck dissection. treated in years 2010-2020, we analyzed the following parameters: age, sex, pT-Status, tumour size, skin invasion, facial nerve palsy, tumour fixation, extraparotid extension, localization, grade, histology, Distribution of T classification was: T3 (60%), and T4 (40%). Results: Mean patient age was 52 years, the most common location of cervical Nodes Met. was level II (72%), then III (49%) then I (42%), then IV (40%) and V (19%). The incidence was highest among patients with (27.9%) mucoepidermoid carcinoma was most common, followed by (14.6%) carcinoma ex-pleomorphic adenoma (9.3%) with acinic cell carcinoma (7%) with squamous cell carcinoma, (11.6%) with adenoid cystic carcinoma, (7.0%) with adenocarcinoma, (7.4%) salivary duct carcinoma, When classified by histological grade, 35% of patients with low/intermediate-grade versus 65.0% high-grade ., Pre-operative fine needle aspiration (83.7%) patients, Post-surgical irradiation was performed in all 43 patients (100%). The resection status (R) was Negative margins R0. (93%), lymphovascular space invasion (44.2%) and (25.6%) had perineural invasion. Skin invasion in (14%) patients, and (4.7%) had regional nodal recurrence (7%) patients with pN1, vs (93%) patients with pN2. Pathologically positive lymph node 4 (range: 1–8 Nodes) lymph nodes harvest 29(range, 23–41 lymph nodes)., Conclusion: modified Radical Neck Dissection with additional radiotherapy should be carried out in patients. Nodes positive parotied cancer especially High histological stage, advanced stage, perineural invasion, positive operative edge, a fixed mass with extra parotid extension facial-nerve paralysis and tumor pain in partied cancer.

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“…Salivary gland carcinomas (SGCs), with an incidence of 12–30 per one million people, are relatively rare malignancies, accounting for more than 0.5% of all malignancies and approximately 1%–8% of head and neck carcinomas worldwide [ 1 – 5 ]. SGCs presented with strong heterogeneity, which leads to different histological subtypes [ 6 ], there are more than 20 different pathological subtypes according to the World Health Organization.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical resection is the standard treatment for localized SGC [ 7 ], radiation and/or chemotherapy are considered in the adjuvant setting. However, the 5-year postoperative recurrence rate ranged from 25 to 46% [ 5 , 8 – 10 ]. Predicting the outcome of SGC patients is challenging for clinicians due to the diversity of tumor behavior.…”

Section: Introductionmentioning

confidence: 99%

Prognostic role of PD-L1 expression in patients with salivary gland carcinoma: A systematic review and meta-analysis

Jiang

Zhu

et al. 2022

PLoS ONE

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Background Although programmed cell death-ligand 1 (PD-L1) has been recognized as a potential marker in several cancers, the relationship between PD-L1 expression and survival in patients with salivary gland carcinoma (SGC) has remained unclear. We aimed to evaluate the association of PD-L1 expression with clinicopathological features and prognosis in SGC patients. Methods The databases Ovid Medline, PubMed, Scopus, and EMBASE were searched for relevant studies that detected PD-L1 expression in SGC. The meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA), and the reporting recommendations for tumor marker prognostic studies (REMARK) was used to assess the quality of research eligible for this meta-analysis. Included studies were assessed using the Quality in Prognosis Studies (QUIPS) tool. Odds ratios (ORs) with 95% confidence interval (CI) were calculated to estimate the correlation between PD-L1 expression and clinicopathological features. Hazard ratios (HRs) with 95% CI were applied to assess the association between PD-L1 expression and survival outcomes of patients. Results A total of ten studies (including 952 patients with SGC) were evaluated. The meta-analysis showed that positive PD-L1 expression in SGC was significantly associated with male patients, older age, Tumor stage, lymph node metastasis, high pathological grade, and non-adenoid cystic carcinoma subtype. The pooled data demonstrated that high PD-L1 expression was associated with poor overall survival and disease-free survival. There was no significant correlation between PD-L1 expression and progression-free survival or disease-specific survival of SGC patients. Conclusion According to the meta-analysis, positive PD-L1 expression may play an important role as an effective marker of poor prognosis in patients with SGC. However, large-scale, prospective investigations are still needed to confirm the findings. The assessment of PD-L1 expression may aid in the personalized management of SGC.

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Management of clinically negative neck in salivary gland cancers – elective neck dissection, irradiation, or surveillance?

Cited by 5 publications

References 15 publications

Elective neck dissection in primary parotid carcinomas: A systematic review and meta‐analysis

Elective neck dissection in primary parotid carcinomas: A systematic review and meta‐analysis

Management of Positive Cervical Lymph Nodes in Parotid Cancer

Prognostic role of PD-L1 expression in patients with salivary gland carcinoma: A systematic review and meta-analysis

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