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Xiao CC, Zhan KY, White-Gilbertson SJ, Day TA. Predictors of Nodal Metastasis in Parotid Malignancies: A National Cancer Data Base Study of 22,653 Patients. Otolaryngol Head Neck Surg 2015; 154:121-30. [PMID: 26419838 DOI: 10.1177/0194599815607449] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/01/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) To identify predictors of nodal disease in parotid malignancies using various clinical and pathologic variables. (2) To examine the effect of nodal disease on overall survival (OS) in parotid cancers STUDY DESIGN Retrospective database review. SETTING National Cancer Data Base (1998-2012). SUBJECTS AND METHODS We identified all cases of primary parotid malignancies in the United States between 1998 and 2012 in the National Cancer Data Base. Eight histopathologies, constituting >80% of all cases, were examined for nodal metastasis and survival. RESULTS We identified 22,653 cases of primary parotid cancer. Eight major histologies were studied, with mucoepidermoid carcinoma (31%), acinic cell carcinoma (18%), adenocarcinoma (14%), and adenoid cystic carcinoma (9%) being most common. Regional nodal disease incidence was 24.4% overall and varied by histopathology. Salivary ductal carcinoma had the highest incidence of both nodal metastasis and occult lymph node metastasis. Overall, N0 patients lived significantly longer than N+ (5-year OS, 79% vs 40%; P < .001). Low-grade disease had significantly better survival than high-grade (5-year OS, 88% vs 69%; P < .001). Occult nodal disease was found in 10.2% and varied by histopathology. CONCLUSION Regional lymph node metastasis significantly decreases survival in many parotid malignancies. High-grade cancers had higher incidences of regional disease than did low grade. Adenocarcinoma had the highest mortality when regional disease was present. Incidence of occult disease varied by histology, but incidence was <10% for all low-grade disease. High T stage and grade are significant independent predictors of nodal disease for most histopathologies.
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Affiliation(s)
- Christopher C Xiao
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kevin Y Zhan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Coca-Pelaz A, Rodrigo JP, Bradley PJ, Vander Poorten V, Triantafyllou A, Hunt JL, Strojan P, Rinaldo A, Haigentz M, Takes RP, Mondin V, Teymoortash A, Thompson LDR, Ferlito A. Adenoid cystic carcinoma of the head and neck--An update. Oral Oncol 2015; 51:652-61. [PMID: 25943783 DOI: 10.1016/j.oraloncology.2015.04.005] [Citation(s) in RCA: 299] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 01/20/2023]
Abstract
This article provides an update on the current understanding of adenoid cystic carcinoma of the head and neck, including a review of its epidemiology, clinical behavior, pathology, molecular biology, diagnostic workup, treatment and prognosis. Adenoid cystic carcinoma is an uncommon salivary gland tumor that may arise in a wide variety of anatomical sites in the head and neck, often with an advanced stage at diagnosis. The clinical course is characterized by very late recurrences; consequently, clinical follow-up should extend at least >15 years. The optimal treatment is generally considered to be surgery with postoperative radiotherapy to optimize local disease control. Much effort has been invested into understanding the tumor's molecular biological processes, aiming to identify patients at high risk of recurrence, in hopes that they could benefit from other, still unproven treatment modalities such as chemotherapy or biological therapy.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Spain
| | - Patrick J Bradley
- Department of Otorhinolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK; European Salivary Gland Society, Geneva, Switzerland
| | - Vincent Vander Poorten
- European Salivary Gland Society, Geneva, Switzerland; Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | - Missak Haigentz
- Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vanni Mondin
- University of Udine School of Medicine, Udine, Italy
| | - Afshin Teymoortash
- Department of Otolaryngology-Head and Neck Surgery, University of Marburg, Marburg, Germany
| | - Lester D R Thompson
- Department of Pathology, Woodland Hills Medical Center, Woodland Hills, CA, USA
| | - Alfio Ferlito
- University of Udine School of Medicine, Udine, Italy.
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Mantsopoulos K, Velegrakis S, Iro H. Unexpected Detection of Parotid Gland Malignancy during Primary Extracapsular Dissection. Otolaryngol Head Neck Surg 2015; 152:1042-7. [DOI: 10.1177/0194599815578104] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the oncologic and functional outcome in cases in which a false preoperative working hypothesis “benign parotid tumor” led to a primary extracapsular dissection being performed rather than a traditional, more radical surgical modality. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects and Methods The records of all patients treated for malignant tumors of the parotid gland between 2006 and 2012 were retrospectively studied. Patients were excluded from our study sample for insufficient data or if their histories indicated manifestation of malignant tumors without primary parotid origin (squamous cell carcinomas, lymphomas, melanomas), revision surgery, as well as concomitant or past malignant tumors. Consequently, a total of 29 patients with 30 primary malignant tumors of the parotid gland formed our study sample (14 men, 15 women; male:female ratio, 0.93:1; mean age, 55.4 years; range, 14-85 years). Results Of 30 cases, 22 had low-grade tumors. Further tumor cells were detected in only the histology specimens of the parotid in 3 of the 25 cases treated subsequently with completion parotidectomy. Five patients received adjuvant radiation. Five-year disease-specific survival was 100%; local disease control was 96.6%. Of 30 cases, 28 had House-Brackmann I after tumor treatment; the other 2 cases had a slight paralysis (House-Brackmann II). Conclusion Beginning with the “false” working hypothesis and performing an extracapsular dissection in unsuspected cases seems to have no adverse impact on patients’ survival and postoperative quality of life in cases in which definitive histology reveals malignancy.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stylianos Velegrakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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O’Connor R, Mitchell DA, Brennan PA. Focused review of investigation, management and outcomes of salivary gland disease in specialty-specific journals. Br J Oral Maxillofac Surg 2014; 52:483-90. [DOI: 10.1016/j.bjoms.2014.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
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Lim CM, Gilbert M, Johnson JT, Kim S. Is level V neck dissection necessary in primary parotid cancer? Laryngoscope 2014; 125:118-21. [DOI: 10.1002/lary.24772] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Chwee M. Lim
- Department of Otolaryngology/Head and Neck Surgery; University of Pittsburgh Medical Center, Eye and Ear Institute; Pittsburgh Pennsylvania U.S.A
- Department of Otolaryngology Head and Neck Surgery; National University Health System; Republic of Singapore
| | - Mark Gilbert
- Department of Otolaryngology/Head and Neck Surgery; University of Pittsburgh Medical Center, Eye and Ear Institute; Pittsburgh Pennsylvania U.S.A
| | - Jonas T. Johnson
- Department of Otolaryngology/Head and Neck Surgery; University of Pittsburgh Medical Center, Eye and Ear Institute; Pittsburgh Pennsylvania U.S.A
| | - Seungwon Kim
- Department of Otolaryngology/Head and Neck Surgery; University of Pittsburgh Medical Center, Eye and Ear Institute; Pittsburgh Pennsylvania U.S.A
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Chen MM, Roman SA, Sosa JA, Judson BL. Histologic grade as prognostic indicator for mucoepidermoid carcinoma: a population-level analysis of 2400 patients. Head Neck 2013; 36:158-63. [PMID: 23765800 DOI: 10.1002/hed.23256] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Mucoepidermoid carcinoma (MEC) is an uncommon malignancy. To the best of our knowledge, this is the largest study investigating disease-specific survival (DSS) of parotid MEC and the first population-level study of the distribution of nodal metastases. METHODS Patients with MEC of the parotid gland were identified in the Surveillance, Epidemiology, and End Results (SEER) database (1988-2009). RESULTS We identified 2400 patients with MEC: 522 low grade, 1137 intermediate grade, and 741 high grade. Five-year DSS rates for low-grade, intermediate-grade, and high-grade MEC were 98.8%, 97.4%, and 67.0%, respectively (p < .001). Negative prognostic factors included high grade, increasing patient age, and tumor size, extraparenchymal extension, nodal metastases, and distant metastases. High-grade MEC was more likely to have lymph node metastases in levels I to III (34.0%) than low-grade (3.3%) and intermediate-grade MEC (8.1%; p < .001). CONCLUSION Grade influences the prognosis and distribution of nodal metastases. Results indicate that management guidelines should vary based on grade.
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Affiliation(s)
- Michelle M Chen
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Poorten VV, Hunt J, Bradley PJ, Haigentz M, Rinaldo A, Mendenhall WM, Suarez C, Silver C, Takes RP, Ferlito A. Recent trends in the management of minor salivary gland carcinoma. Head Neck 2013; 36:444-55. [DOI: 10.1002/hed.23249] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute; Department of Oncology-Head and Neck Oncology; University Hospitals Leuven; KULeuven Belgium
- European Salivary Gland Society; Geneva Switzerland
| | - Jennifer Hunt
- Department of Pathology and Laboratory Services, College of Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Patrick J. Bradley
- European Salivary Gland Society; Geneva Switzerland
- Department of Otolaryngology-Head and Neck Surgery; Nottingham University Hospital; Queens Medical Centre Nottingham United Kingdom
| | - Missak Haigentz
- Division of Oncology; Department of Medicine; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York
| | - Alessandra Rinaldo
- Department of Surgical Sciences; ENT Clinic, University of Udine; Udine Italy
| | | | - Carlos Suarez
- Department of Otolaryngology; Hospital Universitario Central de Asturias; Oviedo Spain
| | - Carl Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
| | - Robert P. Takes
- Department of Otolaryngology-Head and Neck Surgery; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Alfio Ferlito
- Department of Surgical Sciences; ENT Clinic, University of Udine; Udine Italy
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Al-Mamgani A, van Rooij P, Sewnaik A, Tans L, Hardillo JA. Adenoid cystic carcinoma of parotid gland treated with surgery and radiotherapy: Long-term outcomes, QoL assessment and review of the literature. Oral Oncol 2012; 48:278-83. [DOI: 10.1016/j.oraloncology.2011.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/16/2011] [Accepted: 10/19/2011] [Indexed: 12/01/2022]
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