Examined and positive lymph nodes counts and lymph nodes ratio are associated with survival in major salivary gland cancer

Minor salivary gland tumors: A retrospective review of cases in a single centre of south Italy

PURPOSE

Tumors of the minor salivary glands (TMSGs) are rare with heterogeneous behavior despite their low frequency. This study aimed to investigate their distribution characteristics in a single centre of south Italy during the last 10 years and to compare them with similar studies done elsewhere.

MATERIALS AND METHODS

A retrospective study of TMSGs was performed in 110 patients. Data were analyzed using SPSS version 25, Kaplan-Meier analysis was used to find the survival and the outcome hazard ratio was calculated for each variable using Cox regression.

RESULTS

110 patients with TMSGs (55 female ad 55 male, median age 61 years) was examined, including 34 benign and 76 malignant lesions. The palate was the most commonly affected site (41.81 %) in both benign and malignant tumors and the most frequent histological type was respectively pleomorphic adenoma and adenoid cystic carcinoma. Overall survival at 5 years was estimated at 92 %, with statistically significant values for histological high risk and pathological TNM (p value 0.048 and 0.032). Recurrence free survival at 5 years is equal to 82 %.

CONCLUSION

TMSGs have good overall survival despite recurrences. The most significant predictors of outcome are pathological stage and histological risk group.

Prognostic Value of Systemic Inflammatory Markers in Malignant Tumors of Minor Salivary Glands: A Retrospective Analysis of a Single Center

BACKGROUND

Malignant tumors of minor salivary glands (MGSTs) are rare and exhibit significant heterogeneity in terms of etiology, histology and prognosis.

METHODS

This retrospective analysis of 48 resected MGSTs employed Receiver Operating Characteristic (ROC) curves and logistic regression models to evaluate the association between the systemic inflammatory response index (SIRI), the systemic immuno-inflammation index (SII), the neutrophil/lymphocyte ratio (NLR), and the platelet/lymphocyte ratio (PLR) with overall survival (OS). Although these biomarkers showed some correlation with OS, none were statistically significant when considered individually.

RESULTS

Significant correlation was observed between the SIRI, SII, and NLR with overall survival (OS). Among these, SIRI was the most reliable predictor, with an area under the curve (AUC) of 0.713, 80% sensitivity, and 70% specificity.

CONCLUSIONS

While these inflammatory biomarkers correlate with the prognosis and risk stratification of MGSTs, there is currently no clinical utility in decision making due to the lack of standardization and their limited application in clinical practice.

The Role of Blood Inflammatory Markers in Salivary Gland Carcinoma: A Scoping Review

Background/Objectives: Malignant carcinomas of the salivary glands account for approximately 1 to 7% of all head and neck malignancies and approximately 0.3% of all malignant neoplasms. Recently, the scientific community has focused on finding biomarkers that could tailor the treatment for patients with this type of cancer. The neutrophil-lymphocyte ratio (NLR) was the first marker studied and it is one of the most widely used; the platelet-lymphocyte ratio (PLR), the systemic immune inflammation index (SII) and the systemic inflammatory response index (SIRI) have recently emerged as important biomarkers. The aim of this scoping review is to evaluate the role of inflammatory biomarkers in the management of salivary gland malignancies. Methods: A review of the English literature on inflammatory blood markers in major salivary gland cancer was performed using PubMed, Scopus, and Google Scholar databases. The literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for scoping reviews. Results: Eleven full-text articles were included in this review, for a total of 1356 patients in which the role of inflammatory biomarkers (NLR, PLR, SII or SIRI) for the diagnosis and prognosis of salivary gland cancer was assessed. NLR (i) was evaluated in all the studies; (ii) it contributed to the diagnosis and prognosis of both adult and pediatric patients and (iii) can be considered the main biomarker, even if a universal cut-off range is not available yet. PLR, SII and SIRI were introduced more recently and were evaluated only in some studies. Conclusions: The findings of this study suggest that elevated NLR values, regardless of age, are more frequently associated with malignancy and a poor prognosis. Further studies are necessary to evaluate the role of biomarkers other than NLR, and to identify universal and practical cut-off values.

Prognostic Implications of Occult Nodal Metastases in Patients with Clinically N0 Primary Parotid Gland Cancer

Background and Objectives: The role of occult nodal metastases in patients with parotid gland cancers remains unclear; such metastases are histologically diverse and exhibit unpredictable clinical courses. Here, we evaluated the prognostic utilities of such metastases, including metastases in the intraparenchymal lymph nodes (PARs). Materials and Methods: We retrospectively reviewed the medical charts of patients who underwent surgery to treat clinically N0 primary parotid gland cancers from 2000 to 2022. The primary outcome variables were 5-year overall survival (OS) and 5-year disease-free survival (DFS). We explored the effects of occult nodal metastases, including metastases in the PARs, especially in terms of the pathological T (pT) classification. Results: Among 74 patients, 48 (64.8%) were pT1/2 cases, and 26 (35.2%) were pT3/4 cases. Both perineural and lymphatic invasion were negatively associated with the 5-year DFS (hazard ratio [HR] = 3.533, 95% confidence interval [CI] = 1.325-9.421, p = 0.012; HR = 4.028, 95% CI = 1.497-10.839, p = 0.006, respectively). During pathological review, PAR metastases were observed in 12 patients (16.2%), and other occult metastases were present in 8 patients (10.8%). PAR metastases reduced the 5-year DFS in pT1/2 cases (87.2% vs. 22.2%, p = 0.001) but not in pT3/4 cases. Conclusions: PAR metastases significantly reduced the 5-year DFS in patients with clinically N0 primary parotid gland cancer. On subgroup analysis according to pT classification, this effect was significant among patients with early pT1/2 status but not patients with advanced pT3/4 status.

Metastatic lymph node burden impacts overall survival in submandibular gland cancer

Objective

To assess the effect of the number of positive lymph nodes (LNs) on the overall survival (OS) of patients with submandibular gland cancer (SmGC).

Methods

Patients who had undergone neck dissection for SmGC were retrospectively enrolled in this study. The effect of the American Joint Committee on Cancer (AJCC) N stage, the number of positive LNs, LN size, LN ratio, and extranodal extension (ENE) on OS and recurrence-free survival (RFS) was evaluated using Cox analysis. Prognostic models were proposed based on the identified significant variable, and their performance was compared using hazard consistency and discrimination.

Results

In total, 129 patients were included in this study. The number of positive LNs rather than LN ratio, LN size, and ENE was associated with OS. A prognostic model based on the number of positive LNs (0 vs. 1-2 vs. 3+) demonstrated a higher likelihood ratio and Harrell's C index than those according to the 7th/8th edition of the AJCC N stage in predicting OS and RFS.

Conclusions

The effect of LN metastasis on OS and RFS was mainly determined by the number of positive LNs. A validation of this finding is warranted in adenoid cystic carcinomas that were not included in this study.

A retrospective study of nonneoplastic and neoplastic disorders of the salivary glands

The spectrum of major and minor salivary gland disorders varies widely. Epidemiological data on some injury categories are rare and often not up-to-date. This study aims to analyze epidemiological data using clinical, paraclinical, and histopathological parameters. Study was carried out for 5 years on the nonneoplastic and tumoral pathology of the salivary glands. Data were statistically analyzed using the appropriate parameters. Data analysis according to the biological behavior of the lesions revealed great heterogeneity. Statistically significant correlations were observed between the type of injury, age (P = .002) and gender (0.033). The environment of origin of the patients as well as the comorbidities reflected in most cases the nature of the process. Associations were also observed between the biological behavior of the lesions and the hemicranial topography (P = .019), the type of salivary gland (P = .024), and the surgical technique used (P < .001). Most cases were identified in the major salivary glands, often in the parotid. The most common diseases are represented by nonspecific chronic sialadenitis (nonneoplastic lesion), pleomorphic adenoma and Warthin tumor (benign tumors), mucoepidermoid carcinoma (malignant tumor), and squamous carcinoma (secondary tumor). They presented axial diameters between 2 to 95 mm. The most used curative technique was subtotal excision with facial nerve preservation. In conclusion, the study highlighted the main epidemiological aspects of salivary gland disorders. Some data agree with the specialty literature, and particular aspects are also observed. Therefore, this research is useful both in the medical and research fields.

The Combination of Inflammatory Biomarkers as Prognostic Indicator in Salivary Gland Malignancy

Background: The aim of this study was to investigate how the systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), taken individually and combined, are associated with overall survival (OS) in patients surgically treated for malignant salivary gland tumors (MSGTs). Methods: A retrospective analysis of 74 cases following surgery at our department between January 2011 and June 2018 was performed. The Receiver Operating Characteristic (ROC) curve was used to calculate the optimal cutoff values for SII, SIRI, PLR, and NLR. Survival curves of different groups at 1−3−5 years were estimated using the Kaplan−Meier method. Results: The optimal thresholds with the highest sensitivity and specificity were 3.95 for NLR, 187.6 for PLR, 917.585 for SII, and 2.045 for SIRI. The ROC curves revealed that the best combination with AUC = 0.884 was SII + SIRI. The estimated 5-year OS probability in patients with SII+ SIRI scores of 0, 1, and 2 was 96%, 87.5% and 12.5%, respectively (p < 0.001). Conclusion: SII+ SIRI can independently predict the OS of patients after MSGT surgery. The prognostic score system based on SII+ SIRI may be good clinical practice as a reference for clinical decision-making.

Prognostic nomograms for lung neuroendocrine carcinomas based on lymph node ratio: a SEER database analysis

Objective

The current study aimed to explore the prognostic value of the lymph node ratio (LNR) in patients with lung neuroendocrine carcinomas (LNECs).

Methods

Data for 1564 elderly patients with LNECs between 1998 and 2016 were obtained from the Surveillance, Epidemiology, and End Results database. The cases were assigned randomly to training (n = 1086) and internal validation (n = 478) sets. The association between LNR and survival was investigated by Cox regression.

Results

Multivariate analyses identified age, tumor grade, summary stage, M stage, surgery, and LNR as independent prognostic factors for both overall survival (OS) and lung cancer-specific survival (LCSS). Tumor size was also a prognostic determinant for LCSS. Prognostic nomograms combining LNR with other informative variables showed good discrimination and calibration abilities in both the training and validation sets. In addition, the C-index of the nomograms was statistically superior to the American Joint Committee on Cancer (AJCC) staging system in both the training and validation cohorts.

Conclusions

These nomograms, based on LNR, showed superior prognostic predictive accuracy compared with the AJCC staging system for predicting OS and LCSS in patients with LNECs.

Prediction of Long-Term Survival Outcome by Lymph Node Ratio in Patients of Parotid Gland Cancer: A Retrospective study

Background

Lymph node ratio (LNR) has been reported to reliably predict cancer-specific survival (CSS) in parotid gland cancer (PGC). Our study was designed to validate the significance of LNR in patients with PGC.

Methods

Patients diagnosed with stage I–IV PGC were enrolled from Surveillance Epidemiology and End Results database (SEER, N = 3529), which is the training group, and Sun Yat-sen University Cancer Center database (SYSUCC, N = 99), the validation group. We used X-tile software to choose the optimal cutoff value of LNR; then, univariable and multivariable analyses were performed, assessing the association between LNR and CSS.

Results

The optimal cutoff value of LNR was 0.32 by X-tile based on 3529 patients from SEER. Cox proportional hazard regression analysis revealed better CSS for patients with LNR ≤ 0.32 (adjusted hazard ratio [HR] 1.612, 95% confidence interval [95% CI] 1.286–2.019; p < 0.001) compared with patients with LNR > 0.32 in SEER. In the SYSUCC cohort, patients with LNR ≤ 0.32 also had better CSS over patients with LNR > 0.32 (p < 0.001). In N2 and N3 stage groups, patients with LNR ≤ 0.32 had superior CSS outcomes over those with the LNR > 0.32 group, but this benefit was absent in the N1 stage group.

Conclusions

In conclusion, the lymph node ratio turned out to be an independent prognostic factor for cancer-specific survival of PGC in this study. This valuable information could help clinicians to evaluate the prognosis of PGC and suggest that adequate lymph node dissection is necessary.

Nomogram-Based Prediction of Overall and Disease-Specific Survival in Patients With Postoperative Major Salivary Gland Squamous Cell Carcinoma

Background : The major salivary gland squamous cell carcinoma is a rare head and neck tumor, often accompanied by lymph node metastasis. Even if the patient undergoes surgery, the prognosis remains unsatisfactory. To explore the prognostic factors of postoperative major salivary gland squamous cell carcinoma to establish a prognostic risk stratification model to guide clinical practice. Methods: Patients’ information was retrieved from the Surveillance, Epidemiology, and End Results database from 2004 to 2018. Optimal cutoff points were determined using X-tile software, and overall survival and disease-specific survival were calculated by the Kaplan-Meier method. Independent prognostic factors affecting the overall survival and disease-specific survival were identified by multivariate analysis, and corresponding 2 nomogram models were constructed. The discriminative ability and calibration of nomograms were evaluated by the Concordance index, area under curves, and calibration plots. Results: A total of 815 patients with postoperative major salivary gland squamous cell carcinoma were enrolled. The cutoff values for the number of lymph nodes were 2, and the cutoff values for the lymph node ratio were 0.11 and 0.5, respectively. Age, T stage, tumor size, lymph nodes, lymph node ratio, and radiotherapy were prognostic factors for overall survival and disease-specific survival. Nomograms for disease-specific survival and overall survival were established and showed favorable performance with a higher Concordance index and area under curves than that of the tumor–node–metastasis stage and Surveillance, Epidemiology, and End Results stage. The calibration plots of 1-, 3-, and 5-year overall survival and disease-specific survival also exhibited good consistency. What's more, patients were divided into low-, moderate-, and high-risk groups according to the scores calculated by the models. The overall survival and disease-specific survival of patients in the high-risk group were significantly worse than those in the moderate- and low-risk group. Conclusions: Our nomogram integrated clinicopathological features and treatment modality to demonstrate excellent performance in risk stratification and prediction of survival outcomes in patients with major salivary gland squamous cell carcinoma after surgery, with important clinical value.

The prognostic value of lymph node ratio in comparison to positive lymph node count in penile squamous cell carcinoma

PURPOSE

Penile cancer is a rare male neoplasm with a wide variation in its global incidence. In this study, the prognostic value of lymph node ratio (LNR) was compared to that of positive lymph node count (PLNC) in penile squamous cell carcinoma.

METHODS

A total of 249 patients with penile squamous cell carcinoma were enrolled from The Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The X-tile program was used to calculate the optimal cut-off values of LNR and PLNC that discriminate survival. We used the χ2 or the Fisher exact probability test to assess the association between clinical-pathological characteristics and LNR or PLNC. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors for survival. Spearman correlation analysis was used to determine the correlation between LNR and PLNC.

RESULTS

We found that patients with high LNR tended to have advanced N stage, the 7th AJCC stage, and higher pathological grade, while patients with high PLNC had advanced N stage and the 7th AJCC stage. Univariate Cox regression analysis revealed that the N stage, M stage, the 7th AJCC stage, lymph-vascular invasion, LNR, and PLNC were significantly associated with prognosis. Multivariate Cox regression analysis demonstrated that LNR rather than PLNC was an independent prognostic factor for cancer-specific survival. Subgroup analysis of node-positive patients showed that LNR was associated with CSS, while PLNC was not.

CONCLUSION

LNR was a better predictor for long-term prognosis than PLNC in patients with penile squamous cell carcinoma.

Examined and Positive Lymph Node Counts Are Associated with Mortality in Prostate Cancer: A Population-Based Analysis

BACKGROUND

Prostate cancer (PCa) is the third leading cause of death from cancer in the United States. We aimed to disclose the prognostic values of examined (dissected) lymph node (ELN), negative lymph node (NLN), and positive (metastatic) lymph node (PLN) counts and lymph node (LNs) ratio in PCa patients.

METHODS

We extracted data of PCa patients diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) program. We included patients with a histologically confirmed diagnosis having at least one ELN and with the PCa as the primary tumor only.

RESULTS

We have included 96,064 patients. Multivariable Cox proportional hazards regression modelsdisclosed that patients having more ELNs were associated with better survival. However, we demonstrated that patients having more PLNs were associated with worse survival. Additionally, older age, unmarried patients, with Gleason's score of 8-10, T4 and M1 stages and those who received chemotherapy and/or radiation but did not receive surgery were significantly associated with worse PCa survival.

CONCLUSIONS

We have disclosed several independent predictors affecting PCa patients including age, marital status, Gleason's score, T and N stages, having received therapy, surgery, and ELN and PLN counts. Moreover, we demonstrated that patients with lower ELN and higher PLN counts were a high-risk group. We strongly recommend adding the ELN and/or PLN counts into consideration during patient staging/treatment.

Positive lymph node number and extranodal extension for predicting recurrence and survival in patients with salivary gland cancer

BACKGROUND

This study compared our proposed N classification including the addition of the number of positive lymph node (LN+) and extranodal extension (ENE) with the current and previous American Joint Committee on Cancer (AJCC) N classifications in salivary gland cancer (SGC).

METHODS

This study involved 172 SGC patients who underwent surgery. Cox proportional hazard regression analyses were used to identify factors associated with overall survival (OS) and disease-free survival (DFS).

RESULTS

In multivariate analyses, LN+ number, LN ratio, and ENE were associated with OS and DFS outcomes (all P < .05). Our new N classification proposed three categories: N0 (0 LN+), N1 (1 LN+), and N2 (≥2 LN+ or ENE). The C-index of our N classification showed improvement in OS prediction (0.768) compared with the AJCC seventh (0.743) and eighth (0.756) edition N classifications.

CONCLUSIONS

Our proposed N classification incorporating LN+ number and ENE may improve prediction of post-treatment survival and recurrence in patients with SGC.

Sentinel lymph node biopsy in cN0 neck management of parotid cancer

Our goals was to evaluate how sentinel lymph node biopsy (SLNB) benefit neck management in patients with parotid cancer. Patients diagnosed with cN0 parotid cancer by preoperative fine needle puncture were prospectively enrolled. The neck status was evaluated by SLNB. If node metastasis was proved by SLNB, a neck dissection of level I-V a was performed, or a wait-and-see policy was conducted for the patient. All related information was extracted and analyzed. Positive SLNB result occurred in 33 (16.7%) patients, and level II metastasis was noted in 100% of the patients. Isolated level III metastasis was noted in 3 (9.1%) patients. During our follow-up with mean time of 49.5 months, 20 patients developed regional recurrence, in which 6 patients had neck dissection as part of their initial management. All the recurrent neck disease was successfully salvaged. Therefore, SLNB was a reliable procedure for neck management in parotid cancer.