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Mimica X, Yuan A, Hay A, Katabi N, Zanoni DK, Valero C, Shah JP, Wong RJ, Cohen MA, Patel SG, Ganly I. Mucoepidermoid carcinoma: Evaluating the prognostic impact of primary tumor site. Oral Oncol 2021; 123:105602. [PMID: 34768210 DOI: 10.1016/j.oraloncology.2021.105602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/10/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022]
Abstract
Mucoepidermoid carcinoma (MEC) is one of the most common salivary gland malignancies. Our aim was to evaluate the prognostic impact of primary tumor site in patients with MEC. MATERIAL AND METHODS This cohort identified 308 patients with MEC who underwent primary surgery between 1985 and 2015. Survival outcomes were determined using the Kaplan-Meier method. Hazard ratios for primary site were determined using the Cox proportional-hazards model. RESULTS One hundred eighty (58%) patients were diagnosed with minor and 128 (42%) with major salivary gland cancer. Primary site in the minor salivary gland group included 137 (44%) oral cavity, 38 (12%) pharynx, 3 (0.9%) nasal cavity, and 2 (0.6%) trachea and larynx. The major salivary gland group included 118 (38%) parotid, 8 (3%) submandibular, and 2 (0.6%) sublingual. With a median follow-up of 73 months, 5-year overall survival and disease-specific survival were 84% and 91%, respectively. Patients with tumors located in the hard palate and retromolar trigone had the best survival, while patients with tumors located in the paranasal sinuses and submandibular gland had the poorest survival. After controlling for tumor grade and stage, MEC primary site was not predictive of survival or recurrence. On multivariate analysis, worse DSS was associated with stage III-IV tumors (HR: 7,11; 95% CI: 1.19-26.43; p = 0.0034) and high-grade tumors (HR: 19.12; 95% CI: 2.26-162.77; p = 0.0068). CONCLUSIONS While high grade and advanced overall stage were found to be independent predictors of worse survival, primary tumor site was not predictive of poor outcome.
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Affiliation(s)
- Ximena Mimica
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Head and Neck Department of Surgery, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Avery Yuan
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ashley Hay
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nora Katabi
- Department of Pathology, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Daniella Karassawa Zanoni
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Valero
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Snehal G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Abstract
Transoral excision of parapharyngeal space (PPS) tumors has increased in popularity along with the increased use of robotic and endoscopic surgical technology. Here, the authors highlight the indications, techniques, outcomes, and complications of transoral approaches to PPS tumors, with a special emphasis on salivary tumors of the PPS and the transoral robotic surgery approach.
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Kaleem A, Patel N, Alzahrani S, Hatoum H, Tursun R. Concurrent presence of secretory carcinoma and Warthin's tumor in ipsilateral parotid gland. Oral Oncol 2020; 109:104691. [PMID: 32331963 DOI: 10.1016/j.oraloncology.2020.104691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presence of synchronous benign and malignant salivary gland neoplasms is very rare. The authors present a previously unreported combination of Secretory Carcinoma (SC) and Warthin's Tumor (WT) within the same parotid gland. METHODS The patient presented with increasingly painful enlargement of the left parotid gland. CT scan with contrast revealed a heterogeneous solid/cystic mass in the superficial lobe. Fine needle aspiration cytology favored pleomorphic adenoma (PA) and patient underwent superficial parotidectomy without complication. RESULTS Final pathology revealed concomitant presence of SC and WT. Stains were positive for S100 and mammaglobin, and FISH revealed the presence of t(12;15) (p13;q25) translocation, resulting in the ETV6-NTRK3 fusion gene. CONCLUSION It is important for surgeons and pathologists to note the potential for co-existing benign and malignant pathology within the same salivary gland, as this can have an impact on management and prognosis for patients.
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Affiliation(s)
- Arshad Kaleem
- DeWitt Daughtry Family Department of Surgery, Division of Oral and Maxillofacial Surgery, Section of Head and Neck Surgical Oncology/, Microvascular Reconstructive Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Deering Medical Plaza, 9380 SW 150(th) St #170, Miami, FL 33176, United States.
| | - Neel Patel
- DeWitt Daughtry Family Department of Surgery, Division of Oral and Maxillofacial Surgery, Section of Head and Neck Surgical Oncology/, Microvascular Reconstructive Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Deering Medical Plaza, 9380 SW 150(th) St #170, Miami, FL 33176, United States.
| | - Shadi Alzahrani
- Fellow Head and Neck Oncology, Microvascular Surgery, Department of Oral and Maxillofacial Surgery, University of Michigan, 2229 S State st unit 112, Ann Arbor, MI 48104, United States.
| | - Hisham Hatoum
- Oral and Maxillofacial Surgery, Veteran's Affairs Medical Center, 1201 NW 16(th) St, Miami, FL 33125, United States.
| | - Ramzey Tursun
- DeWitt Daughtry Family Department of Surgery, Division of Oral and Maxillofacial Surgery, Section of Head and Neck Surgical Oncology/, Microvascular Reconstructive Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Deering Medical Plaza, 9380 SW 150(th) St #170, Miami, FL 33176, United States.
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Israel Y, Rachmiel A, Gourevich K, Nagler R. Mortality rates and prognostic factors in patients with malignant salivary tumors. Med Oncol 2019; 36:65. [PMID: 31165942 DOI: 10.1007/s12032-019-1284-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/18/2019] [Indexed: 11/26/2022]
Abstract
Malignancies of the salivary glands represent a multifarious disease. Evaluating the prognostic factors of these malignancies may help predict patient outcome and aid decision-making in choosing the most suitable therapy. We examined the role of various salivary tumorigenic, clinical and therapeutic features in a cohort of 101 patients diagnosed and treated for primary malignant salivary tumors. These include histo-pathological diagnosis, stage, grade and T, N, M values as well as the existence of perineural invasion and extra-parenchymal spread. We also identified the salivary gland involved, the sub-compartment specific location of the tumor and the therapy administered. All these were related to mortality. Of the 101 patients examined, 79 survived and 22 died due to the disease. Tumor staging, distant metastasis and perineural invasion were highly significant predictors of increased lethality. Histo-pathological grading was also a predictor but to a lesser degree. Neither neck metastasis nor tumor size or type had a significant impact on lethality. Performing neck dissections did not decrease lethality rate. Location of the tumor in the parotid gland and more so in its deep lobe adversely affected lethality; extra-parenchymal spread also had an adverse effect. Our results seem to indicate hematogenous rather than lymphogenous spread of metastasis from malignant salivary tumors. The highest therapeutic priority should be achieving full local control of the disease by safe removal of the primary salivary tumor, accompanied by regional control of perineural invasion and extra-parenchymal spread and appropriate systemic treatment aimed at eradicating distant metastasis.
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Affiliation(s)
- Yair Israel
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, 31096, Haifa, Israel
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, 31096, Haifa, Israel
| | - Konstantin Gourevich
- Department of Nuclear Medicine, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, 31096, Haifa, Israel
| | - Rafael Nagler
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, 31096, Haifa, Israel.
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Israel Y, Rachmiel A, Gourevich K, Nagler R. Survival Probabilities Related to Histology, Grade and Stage in Patients With Salivary Gland Tumors. Anticancer Res 2019; 39:641-647. [PMID: 30711940 DOI: 10.21873/anticanres.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The diversity of malignant salivary gland tumors challenges the study of survival rates. The current study evaluated patient survival rates using Kaplan-Meier analysis and examined the relative effects of histology, grade and stage on survival. MATERIALS AND METHODS Using the Kaplan-Meier model, cancer-specific (CSS) and disease-free (DFS) survival probabilities were calculated as a function of time. RESULTS Of 101 patients, 79 survived and 22 died of their disease. The probability of CSS was 0.83, 0.73 and 0.61 at 5, 10 and 15 years, respectively; corresponding probability of DFS was 0.69, 0.59 and 0.54, respectively. CONCLUSION CSS and the DFS probabilities in patients with salivary malignancies were quite high at 5 years, although these rates dropped over the long-term; the lethal effect of the malignancy is often delayed and prolonged. Tumor histology, grade and stage are well established factors in predicting prognosis. Although the subgroups of patients with MECA and SCC were too small to allow adequate statistical analysis, clear tendencies for devastating effects of poor differentiation in SCC and higher grade in MECA were shown. That is, 2/4 patients with high-grade MECA died from their disease, while only 1/15 with low-intermediate grade MECA died from their disease. Similarly, 2/4 patients with poorly differentiated SCC died from their disease, while only 1/5 with well-to-moderately-differentiated SCC died from their disease. Factors such as molecular markers should be further studied in an effort to improve prognosis prediction.
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Affiliation(s)
- Yair Israel
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, Haifa, Israel
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, Haifa, Israel
| | - Konstantin Gourevich
- Department of Nuclear Medicine Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion -Israel Institute of Technology, Haifa, Israel
| | - Rafael Nagler
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, Haifa, Israel
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