Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients

Clinical outcomes and prognostic indicators in parotid gland carcinomas: a single-center experience

BACKGROUND

Parotid gland cancers (PGC) are a heterogeneous group with different histological types and grades. This difference has implications for patient management and adjuvant treatment decisions.

OBJECTIVE

This study aims to determine the poor prognostic factors affecting local control and survival in PGC.

MATERIALS AND METHODS

A retrospective review of 42 patients treated for malignant parotid masses between January 2008 and December 2023. Risk factors analyzed included sex, age, histological grade, tumor size, stage, nodal involvement, perineural invasion (PNI), surgical margins, and additional treatments.

RESULTS

Of the 42 patients, 47.6% were male, and the median age was 44 years. The 5-year local relapse-free survival (LRFS) was 69.7%. Positive surgical margins significantly associated with lower LRFS rate (p = .007). The 5-year disease-specific survival (DSS) was 83.9%, with surgical margin and T stage being significant prognostic factors (0.044 and 0.031, respectively). Advanced T stage was associated with a higher rate of preoperative facial nerve dysfunction (p = .004).

CONCLUSIONS AND SIGNIFICANCE

This study underscores the critical role of comprehensive diagnostic and individualized surgical strategies in the treatment of parotid gland malignancies.

Clinicopathological, Prognostic and Molecular Profile of Salivary Gland Intraductal Carcinoma: A Systematic Review

PURPOSE

This study aimed to conduct a systematic review summarizing the clinicopathological, prognostic, and molecular features of salivary gland intraductal carcinoma (SGIC).

METHODS

This study followed the PRISMA 2020 guidelines and was registered in the PROSPERO database. It included case reports, case series studies, and cohort studies of SGIC indexed in the PubMed, Web of Science, Scopus, and Embase databases published between 1983 and 2024. Collected variables underwent descriptive analysis, association analysis using Fisher's tests, and Kaplan-Meier analysis. The quality assessment of the included studies was conducted using the Joanna Briggs Institute tools.

RESULTS

This systematic review yielded 59 studies, comprising 186 SGIC cases. Most of cases involved the parotid gland of male patients around 60 years old. Lesions predominantly exhibited noninvasive growth, an intercalated duct phenotype, and minimal pleomorphism. Most of the patients did not develop recurrent or metastatic disease, indicating a good prognosis. However, male sex, invasive lesions, adjuvant treatments, high-grade lesions, as well as lymph node or distant metastasis negatively affected the survival rates. Overall SGIC cases showed S100, mammaglobin, SOX10, AR, CK7, p63, calponin, CK14, SMA, and p40 positivity and a low Ki67 index. Common molecular alterations included NCOA4-RET, TRIM33-RET, and TRIM27-RET fusions, and HRAS, PIK3CA, and BRAF V600E mutations.

CONCLUSION

SGIC is a histopathologically and molecularly heterogeneous lesion with an overall excellent prognosis. The presence of invasive lesions, as well as lymph node or distant metastasis, has emerged as one of the most critical prognostic factors in SGIC patients.

An Unusual Case of Metachronous Tumors of Prostate and Parotid Gland: A Diagnostic Dilemma

If diagnosed early, prostate cancer (PCa) has a good prognosis and an excellent five-year survival rate. However, this favorable behavior can be drastically worsened by the presence of another synchronous or metachronous higher-grade malignancy. In the current case report, we present and analyze a 76-year-old patient who underwent radical prostatectomy because of prostate gland adenocarcinoma, diagnosed on needle biopsy. The low Gleason score and the early stage of the PCa are in significant contrast with the widespread metastatic disease that is observed during the follow-up. Additional clinical examination, imaging, and histological evaluation reveal a high-grade salivary duct carcinoma, a metachronous primary in the left parotid gland. The presence of these two malignancies raises a series of diagnostic difficulties faced by medical professionals, in part because of the tendency of prostate gland and salivary gland tumors to show some overlapping features regarding their biological behavior and immunohistochemical aspects.

High-grade transformation of adenoid cystic carcinoma of parotid gland with isolated intratemporal facial nerve involvement: a case report and literature review

Background

High-grade transformation Adenoid cystic carcinoma (HGT-AdCC) of the parotid gland is a rare transformation noted in slow growing low grade AdCC. Perineural invasion and spread is an important feature of this tumor. Temporal bone involvement is rare. A total of only 10 cases of HGT-AdCC in parotid gland has been reported in literature so far predominantly in the elderly with peak incidence in 5th–6th decade.

Case presentation

We present a young lady of HGT-AdCC of right parotid gland with temporal bone involvement in the form of isolated perineural invasion (PNI) of facial nerve till the tympanic segment. She underwent right radical parotidectomy with modified radical neck dissection with modified lateral temporal bone resection and pectoralis major myocutaneous flap reconstruction. Histopathological examination revealed both low- and high-grade areas. Sections from facial nerve showed tumor invasion.

Conclusion

The radiological features of isolated perineural spread in intratympanic part of facial nerve can be easily missed if not specifically looked for. Every attempt should be made preoperatively and intraoperatively to determine the complete extent of the tumor for adequate disease clearance. A combined clinico-radiological approach aided by histopathology examination helps in early detection of this carcinoma and in better patient management.

Clinico-Epidemiological Analysis of Most Prevalent Parotid Gland Carcinomas in Poland over a 20-Year Period

(1) Background: Malignant tumours of the salivary glands have different clinical and histopathological characteristics. They most commonly involve the parotid gland. Histopathologically, the most common are mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), acinic cell carcinoma (AcCC), adenocarcinoma, carcinoma in pleomorphic adenoma (CPA), and squamous cell carcinoma (SCC). (2) Methods: We analysed 2318 patients with malignant parotid gland tumours reported to the National Cancer Registry (NCR) in Poland over 20 years (1999-2018). The demographic characteristics of patients, clinical factors, and overall survival (OS) were analysed. (3) Results: The average age was 61.33 ± 16.1 years. The majority were males (55%) and urban citizens (64%). High percentage of carcinomas was diagnosed in locoregional (33.7%) and systemic (10.4%) stadium. The most prevalent diagnoses were SCC (33.3%) and adenocarcinoma (19.6%). Surgical resection with adjuvant RT (42.1%) was the most common treatment. The OS analysis showed a median survival time of 5.6 years. The most favorable median OS was found in patients with AcCC (18.30 years), the worst for SCC (1.58 years). (4) Conclusion: AcCC has the best prognosis and SCC the worst. Tumour stadium, treatment, and demographic factors affect prognosis. Improvements in diagnosis and re-evaluation of treatment standards are necessary to enhance the outcome of patients with parotid gland cancers in Poland.

Outcomes of Oral and Oropharyngeal Squamous Cell Carcinoma Related to Healthcare Coverage: A Retrospective Cohort Study in Brazil

We investigated the differences in prognosis according to the type of healthcare coverage of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). This study included 875 medical records. Patients covered by the publicly funded Unified Health System (SUS) had a low educational level, with advanced T stage and delayed treatment initiation. Multivariate analyses revealed an association between T stage (p = .035) and poor prognosis in oral squamous cell carcinoma, and age (p = .029) in oropharyngeal squamous cell carcinoma. Surgical treatment (p = .036) and marital status (p = .015) were considered predictors of better prognosis in OOSCC. Exclusive SUS-dependency can be considered an indirect prognostic factor for OOSCC.

Nomogram Predicting Cancer-Specific Death in Parotid Carcinoma: a Competing Risk Analysis

PURPOSE

Multiple factors have been shown to be tied to the prognosis of individuals with parotid cancer (PC); however, there are limited numbers of reliable as well as straightforward tools available for clinical estimation of individualized mortality. Here, a competing risk nomogram was established to assess the risk of cancer-specific deaths (CSD) in individuals with PC.

METHODS

Data of PC patients analyzed in this work were retrieved from the Surveillance, Epidemiology, and End Results (SEER) data repository and the First Affiliated Hospital of Nanchang University (China). Univariate Lasso regression coupled with multivariate Cox assessments were adopted to explore the predictive factors influencing CSD. The cumulative incidence function (CIF) coupled with the Fine-Gray proportional hazards model was employed to determine the risk indicators tied to CSD as per the univariate, as well as multivariate analyses conducted in the R software. Finally, we created and validated a nomogram to forecast the 3- and 5-year CSD likelihood.

RESULTS

Overall, 1,467 PC patients were identified from the SEER data repository, with the 3- and 5-year CSD CIF after diagnosis being 21.4% and 24.1%, respectively. The univariate along with the Lasso regression data revealed that nine independent risk factors were tied to CSD in the test dataset (n = 1,035) retrieved from the SEER data repository. Additionally, multivariate data of Fine-Gray proportional subdistribution hazards model illustrated that N stage, Age, T stage, Histologic, M stage, grade, surgery, and radiation were independent risk factors influencing CSD in an individual with PC in the test dataset (p < 0.05). Based on optimization performed using the Bayesian information criterion (BIC), six variables were incorporated in the prognostic nomogram. In the internal SEER data repository verification dataset (n = 432) and the external medical center verification dataset (n = 473), our nomogram was well calibrated and exhibited considerable estimation efficiency.

CONCLUSION

The competing risk nomogram presented here can be used for assessing cancer-specific mortality in PC patients.