Advertisement

Kaplan–Meier analysis of salivary gland tumors: prognosis and long-term survival

  • Yair Israel
  • Adi Rachmiel
  • Konstantin Gourevich
  • Rafael NaglerEmail author
Original Article – Clinical Oncology
  • 20 Downloads

Abstract

Purpose

We evaluated the impact of various tumor related parameters on survival probability in a cohort of patients with malignant salivary tumors, using the Kaplan–Meier analysis.

Methods

We measured patients up to 15 years following therapy, looking at T N M stage, grade perineural invasion and extra-parenchymal spread.

Results

Of 101 patients diagnosed with various salivary malignant tumors in our medical center, 79 patients survived while 22 died with disease (DWD). The impact of distant metastasis (M+) was devastating (survival probability at 60 months and at 180 months dropped from 0.93 (M−) to 0.40 (M+) and from 0.67 to 0.40, respectively, p = 0.0001), the impact of perineural invasion was severe (at 180 months the probability of survival dropped from 0.75 to 0.21, p = 0.002). Higher stage tumor also decreased survival (from 0.82 to 0.53 at 180 months, p = 0.002) as did poor histological grade (from 0.85 to 0.48 at 180 months, p = 0.019). Neck metastasis (N+) impact was quite moderate (at 180 months the probability of survival dropped from 0.69 to 0.58, p = 0.044) while neither tumor size (T) nor extra-parenchymal spread significantly affected survival.

Conclusions

Salivary tumor location and its potential to infiltrate nerves and blood vessels and to metastasize is the most telling parameter. Systemic therapy aimed at halting distant metastatic spread is the most effective therapeutic goal. Dissection of N0 neck metastasis is not necessarily a valuable treatment.

Keywords

Salivary tumors Survival Prognosis Kaplan–Meier Perineural Extra-parenchymal 

Notes

Funding

This study did not receive funding of any kind.

Compliance with ethical standards

Conflict of interest

Yair Israel declares no conflict of interest, financial or otherwise, relating to this study. Adi Rachmiel declares no conflict of interest, financial or otherwise, relating to this study. Konstantin Gourevich declares no conflict of interest, financial or otherwise, relating to this study. Rafael Nagler declares no conflict of interest, financial or otherwise, relating to this study.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent forms were not necessary for this study, as the study had no effect on patient management or identification.

References

  1. Badlani J, Gupta R, Balasubramanian D, Smith J, Luk P, Clark J (2018) Primary salivary gland malignancies: a review of clinicopathological evolution, molecular mechanisms and management. ANZ J Surg 88(3):152–157.  https://doi.org/10.1111/ans.14201 CrossRefGoogle Scholar
  2. Barnes L, Eveson JW, Reichart P (2005) World Health Organization classification of tumors: Pathology and genetics of head and neck tumors. IARC Press, LyonGoogle Scholar
  3. Bjorndal K, Krogdahl A, Therkildsen MH, Overgaard J, Johansen J, Kristensen CA, Homøe P, Sørensen CH, Andersen E, Bundgaard T et al (2012) Salivary gland carcinoma in Denmark 1990–2005: outcome and prognostic factors. Results of the Danish Head and Neck Cancer Group (DAHANCA). Oral Oncol 48:179–185CrossRefGoogle Scholar
  4. Carlson ER, Schlieve T (2019) Salivary gland malignancies. Oral Maxillofac Surg Clin N Am 31:125–144CrossRefGoogle Scholar
  5. Cho JK, Lim BW, Kim EH, Ko YH, Oh D, Noh JM, Ahn YC, Baek KH, Jeong HS (2016) Low-grade salivary gland cancers: treatment outcomes, extent of surgery and indications for postoperative adjuvant radiation therapy. Ann Surg Oncol 23:4368–4375CrossRefGoogle Scholar
  6. D’heygere E, Meulemans J, Vander Poorten V (2018) Salivary duct carcinoma. Curr Opin Otolaryngol Head Neck Surg 26:142–151CrossRefGoogle Scholar
  7. Eppsteiner RW, Fowlkes JW, Anderson CM, Robinson RA, Pagedar NA (2017) Aggressive salivary malignancies at early stage: outcomes and implications for treatment. Ann Otol Rhinol Laryngol 126(7):525–529.  https://doi.org/10.1177/0003489417702655 CrossRefGoogle Scholar
  8. Frankenthaler RA, Luna MA, Lee SS, Ang KK, Byers RM, Guillamondegui OM, Wolf P, Goepfert H (1991) Prognostic variables in parotid gland cancer. Arch Otolaryngol Head Neck Surg 117:1251–1256CrossRefGoogle Scholar
  9. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L (2010) Major and minor salivary gland tumors. Crit Rev Oncol Hematol 74:134–148CrossRefGoogle Scholar
  10. Herman MP, Werning JW, Morris CG, Kirwan JM, Amdur RJ, Mendenhall WM (2013) Elective neck management for high-grade salivary gland carcinoma. Am J Otolaryngol 34:205–208CrossRefGoogle Scholar
  11. Inouye CM, Anagnostou V, Li QK (2017) Primary parotid adenocarcinoma metastasis to the spleen with PIK3CA mutation: cytological findings and review of the literature. Int J Clin Exp Pathol 10:5999–6005Google Scholar
  12. Jeannon JP, Calman F, Gleeson M, Tan IB, Keus RB, Hart AA (2009) Management of advanced parotid cancer. A systematic review. Eur J Surg Oncol. 35:908–915CrossRefGoogle Scholar
  13. Johnston M, Yu E, Kim J (2012) Perineural invasion and spread in head and neck cancer. Expert Rev Anticancer Ther 12:359–371CrossRefGoogle Scholar
  14. Kopec T, Mikaszewski B, Jackowska J, Waśniewska-Okupniak E, Szyfter W, Wierzbicka M (2015) Treatment of parotid malignancies—10 years of experience. J Oral Maxillofac Surg 73:1397–1402CrossRefGoogle Scholar
  15. Kruse AL, Gratz KW, Obwegeser JA, Lubbers HT (2010) Malignant minor salivary gland tumors: a retrospective study of 27 cases. Oral Maxillofac Surg 14:203–209CrossRefGoogle Scholar
  16. Li Q, Zhang X-R, Liu X-K, Liu Z-M, Liu W-W, Li H, Guo Z-M (2012) Long-term treatment outcome of minor salivary gland carcinoma of the hard palate. Oral Oncol 48:456–462CrossRefGoogle Scholar
  17. Lobo R, Hawk J, Srinivasan A (2018) A review of salivary gland malignancies: common histologic types, anatomic considerations, and imaging strategies. Neuroimaging Clin N Am 28:171–182CrossRefGoogle Scholar
  18. McGurk M (2001) Management of salivary gland cancer: clinically or pathologically based? Overview. In: McGurk M, Renehan A (eds) Controversies in the management of salivary gland disease. Oxford University Press, Oxford, pp 155–161Google Scholar
  19. McHugh CH, Roberts DB, El-Naggar AK, Hanna EY, Garden AS, Kies MS, Weber RS, Kupferman ME (2012) Prognostic factors in mucoepidermoid carcinoma of the salivary glands. Cancer 118:3928–3936CrossRefGoogle Scholar
  20. Munhoz L, Ramos EADA, Im DC, Hisatomi M, Yanagi Y, Asaumi J, Arita ES (2019) Application of diffusion-weighted magnetic resonance imaging in the diagnosis of salivary gland diseases: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol.  https://doi.org/10.1016/j.oooo.2019.02.020 Google Scholar
  21. Nakano K, Sato Y, Sasaki T, Shimbashi W, Fukushima H, Yonekawa H, Mitani H, Kawabata K, Takahashi S (2016) Combination chemotherapy of carboplatin and paclitaxel for advanced/metastatic salivary gland carcinoma patients: differences in responses by different pathological diagnoses. Acta Otolaryngol 136:948–951CrossRefGoogle Scholar
  22. Neville BW (2008) Oral and maxillofacial pathology, 3rd edn. Saunders/Elsevier, St. LouisGoogle Scholar
  23. Nobis CP, Rohleder NH, Wolff KD, Wagenpfeil S, Scherer EQ, Kesting MR (2014) Head and neck salivary gland carcinomas—elective neck dissection, yes or no? J Oral Maxillofac Surg 72:205–210CrossRefGoogle Scholar
  24. Radomski S, Dermody S, Harley EH Jr (2018) Clinical characteristics and outcomes of major salivary gland malignancies in children. Laryngoscope 128(5):1126–1132.  https://doi.org/10.1002/lary.26946 CrossRefGoogle Scholar
  25. Ranjbar MA, Ranjbar Z, Zahed M, Nikookar N (2019) CD73 a novel marker for the diagnosis of benign and malignant salivary gland tumors. J Clin Exp Dent 11(3):e213–e218.  https://doi.org/10.4317/jced.54918 Google Scholar
  26. Renehan AG, Gleave EN, Slevin NJ, McGurk M (1999) Clinicopathological and treatment-related factors influencing survival in parotid cancer. Br J Cancer 80:1296–1300CrossRefGoogle Scholar
  27. Schmitt AC, McCormick R, Cohen C, Siddiqui MT (2014) DOG1, p63, and S100 protein: a novel immunohistochemical panel in the differential diagnosis of oncocytic salivary gland neoplasms in fine-needle aspiration cell blocks. J Am Soc Cytopathol 3(6):303–308CrossRefGoogle Scholar
  28. Seethala RR (2017) Salivary gland tumors: current concepts and controversies. Surg Pathol Clin 10(1):155–176CrossRefGoogle Scholar
  29. Slevin N, Frankenthaler R (2001) The role of radiotherapy in the management of salivary gland cancer. In: McGurk M, Renehan A (eds) Controversies in the management of salivary gland disease. Oxford University Press, Oxford, pp 163–172Google Scholar
  30. Speight PM, Barrett AW (2009) Prognostic factors in malignant tumours of the salivary glands. Br J Oral Maxillofac Surg 47:587–593CrossRefGoogle Scholar
  31. Spiro RH (2001) Factors affecting survival in salivary gland cancers. In: McGurk M, Renehan A (eds) Controversies in the management of salivary gland disease. Oxford University Press, Oxford, pp 143–150Google Scholar
  32. Stennert E, Kisner D, Jungehuelsing M, Guntinas-Lichius O, Schröder U, Eckel HE, Klussmann JP (2003) High incidence of lymph node metastasis in major salivary gland cancer. Arch Otolaryngol Head Neck Surg 129:720–723CrossRefGoogle Scholar
  33. Stodulski D, Mikaszewski B, Stankiewicz C (2012) Are all prognostic factors in parotid gland carcinoma well recognized? Eur Arch Otorhinolaryngol 269:1019–1025CrossRefGoogle Scholar
  34. Terhaard CH, Lubsen H, Van der Tweel I, Hilgers FJ, Eijkenboom WM, Marres HA, Tjho-Heslinga RE, de Jong JM, Roodenburg JL, Dutch Head and Neck Oncology Cooperative Group (2004) Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head Neck 26:681–692CrossRefGoogle Scholar
  35. Walvekar RR, Filho PAA, Seethala RR, Gooding WE, Heron DE, Johnson JT, Ferris RI (2011) Clinicopathologic features as stronger prognostic factors than histology or grade in risk stratification of primary parotid malignancies. Head Neck 33:225–231CrossRefGoogle Scholar
  36. Witt RL (1999) Facial nerve function after partial superficial parotidectomy. Otolaryngol Head Neck Surg 121:210–213CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical SciencesTechnion-Israel Institute of TechnologyHaifaIsrael
  2. 2.Department of Nuclear Medicine, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical SciencesTechnion-Israel Institute of TechnologyHaifaIsrael

Personalised recommendations