Predictors of outcomes in large cell undifferentiated carcinoma of the major salivary glands

Schrank, Travis P.; Zhan, Kevin Y.; Lentsch, Eric J.

doi:10.1002/lary.26136

Cited by 5 publications

(7 citation statements)

References 26 publications

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“…001) further emphasize the importance of a margin‐free resection. Prior studies evaluating cohorts of parotid cancer or mixed major and minor salivary malignancies reported decreased OS with positive margins 22–25,29,47 . However, this was not confirmed in studies restricted to submandibular carcinoma, likely due to low power.…”

Section: Discussionmentioning

confidence: 90%

“…Prior studies evaluating cohorts of parotid cancer or mixed major and minor salivary malignancies reported decreased OS with positive margins. 22-25,29,47 However, this was not confirmed in studies restricted to submandibular carcinoma, likely due to low power. Cohen et al 20 evaluated 22 patients with submandibular adenoid cystic carcinoma and found that OS did not differ by margin status.…”

Section: Discussionmentioning

confidence: 98%

“…18,19 Available literature indicates positive margins in salivary cancer are independently associated with worse locoregional control and survival. 11,[20][21][22][23][24][25] While clinical and institutional factors predictive of positive margins have been analyzed in other HNC sites, [26][27][28] including the parotid gland, 29 little is known about positive margins in submandibular malignancies.…”

mentioning

confidence: 99%

“…Salivary cancers have reportedly higher rates of positive margins compared to other HNC sites, 14–17 but limited large‐population data exist in submandibular malignancies as a separate entity 18 , 19 . Available literature indicates positive margins in salivary cancer are independently associated with worse locoregional control and survival 11,20–25 . While clinical and institutional factors predictive of positive margins have been analyzed in other HNC sites, 26–28 including the parotid gland, 29 little is known about positive margins in submandibular malignancies.…”

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confidence: 99%

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Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

Benchetrit

Morse

Judson

et al. 2019

Otolaryngol.--head neck surg.

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Objectives Identify positive margin rate in a national cohort of patients with submandibular carcinoma, identify predictors of positive margins, and associate margins with overall survival. Study Design Retrospective cohort. Setting Commission on Cancer–accredited hospitals. Subjects and Methods We included patients in the National Cancer Database from 2004 to 2014 who were diagnosed with submandibular carcinoma and underwent primary surgical resection. We determined the rate of positive surgical margins and associated patient, tumor, and treatment factors with positive margins via univariable and multivariable logistic regression analysis. We associated margin status with overall survival by Kaplan-Meier curve and Cox proportional hazards regression. Results We identified 1150 patients with submandibular malignancy undergoing surgical resection. Positive margin rate was 41.0%. Increased odds of positive margins were seen in patients with advanced T stage (vs T1, T3: odds ratio [OR] = 3.04, P < .001; T4a: OR = 2.89, P < .001), adenoid cystic carcinoma histology (OR = 1.54, P = .020), and those treated at nonacademic facilities (OR = 1.41, P = .008). Patients who underwent a preoperative diagnostic biopsy had decreased odds of positive margins (OR = 0.72, P = .014). Positive margins were associated with reduced overall survival (58% vs 69% 5-year overall survival, P < .001; hazard ratio = 1.49, P = .001) when controlling for patient, tumor, and management factors. Conclusions The national positive margin rate of submandibular carcinoma is 41.0%. Preoperative biopsy and treatment at academic institutions independently decreased the risk of positive margins, and positive margins were independently associated with diminished overall survival. Positive margin rate for submandibular carcinoma may be considered a benchmark for quality of care.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

Benchetrit

Morse

Judson

et al. 2019

Otolaryngol.--head neck surg.

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“…Fifty‐one studies comprising a total of 11 698 patients (5636 [48%] males) were included 3,15–66 . The mean age was 57.1 years, range 2–97 years.…”

Section: Resultsmentioning

confidence: 99%

Elective neck dissection in salivary gland malignancies: Systematic review and meta‐analysis

et al. 2021

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We defined the occult nodal metastasis (ONM) rate of clinical node‐negative salivary gland malignancies and examined the role of elective neck dissection (END). Meta‐analysis querying four databases, from inception of databases to March 25th, 2020. Fifty‐one studies with 11 698 patients were included. ONM rates were 64% for salivary ductal carcinoma (SDC), 51% for undifferentiated carcinoma, 34% for carcinoma ex‐pleomorphic adenoma (CXPA), 32% for adenocarcinoma not otherwise specified (ANOS), 31% for lymphoepithelial carcinoma (LE), 20% for mucoepidermoid carcinoma, 17% for acinic cell carcinoma, and 17% for adenoid cystic carcinoma. T3/T4 tumors had a 2.3 times increased risk of ONM than T1/T2 tumors. High‐grade tumors had a 3.8 times increased risk of ONM than low/intermediate‐grade tumors. ONM rates were exceedingly high for T3/T4, high‐grade, and undifferentiated, SDC, ANOS, CXPA, and LE tumors, indicating the potential role of END.

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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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Predictors of outcomes in large cell undifferentiated carcinoma of the major salivary glands

Abstract: 4. Laryngoscope, 2016 127:372-376, 2017.

Cited by 5 publications

References 26 publications

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

Elective neck dissection in salivary gland malignancies: Systematic review and meta‐analysis

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

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