Kevin Y. Zhan

Predictors of Nodal Metastasis in Parotid Malignancies A National Cancer Data Base Study of 22,653 Patients

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.

Basal cell adenocarcinoma of the major salivary glands: A population-level study of 509 cases.

We sought to better characterize patient, tumor, and long‐term survival characteristics of basal cell adenocarcinoma (BCAC) of the major salivary glands with the National Cancer Database (NCDB).

Oncocytic carcinoma of the major salivary glands: A population‐based study of 278 cases

Oncocytic carcinomas of the major salivary glands are extremely rare, with <100 cases reported.

Benign Parotid Tumors.

This article reviews the epidemiology, embryology, risk factors, clinical presentation, diagnostic work-up, and basic management principles for the more common benign parotid neoplasms. The various histopathologies are also discussed and summarized.

Lymphoepithelial carcinoma of the major salivary glands: Predictors of survival in a non-endemic region

INTRODUCTION Lymphoepithelial carcinoma (LEC) of the salivary glands is extremely rare worldwide, with studies limited to small case reports and case series from endemic areas (Southern China, Arctic Inuits) and strong association to Epstein Barr Virus (EBV). Studies on non-endemic regions are even more limited given the reality of only sporadic cases in these areas. Using the National Cancer Database (NCDB), we present the largest study on salivary LEC from a non-endemic region, the United States. METHODS A retrospective review of the NCDB from 1998-2012 for LEC of the major salivary glands was performed. Demographic and clinical variables were extracted for analysis. Multivariate COX regression was used to assess predictors of survival. RESULTS Two hundred and thirty-eight cases were identified (0.66% of all salivary cancers). Median age at diagnosis was 62 with peak incidence in ages 50-70. Most patients were Caucasian (81.2%), without gender preference. Regional metastasis was common (45.1%) and did not significantly impact survival. Distant metastasis was rare (2%). Overall survival (OS) at 5- and 10 years was 77% and 56%. Surgery and radiotherapy significantly showed better survival outcomes than surgery alone (p<0.001). Age >62, advanced stage, and dual modality therapy were significant predictors of survival in multivariate analysis. CONCLUSION Lymphoepithelial carcinoma in the US mostly affects an older, Caucasian demographic. Regional metastasis is common and survival is fair at 5- and 10 years. Surgery and radiation are recommended for early and advanced disease stages. Age, stage, and therapy are significant predictors of survival outcomes.

Risk Factors Associated With Unplanned Readmission in Patients Undergoing Parotid Cancer Surgery: A Study of the National Cancer Database

IMPORTANCE Thirty-day unplanned readmissions are increasingly used as a measure of quality care. OBJECTIVE To describe the incidence of and risk factors for 30-day unplanned readmissions for patients undergoing treatment for cancer of the parotid gland. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted using the National Cancer Database. Records on patients in the database undergoing surgery for previously untreated primary parotid cancer between 2003 and 2012 were reviewed. The data were analyzed in October 2015. INTERVENTIONS Parotidectomy with or without neck dissection. MAIN OUTCOMES AND MEASURES The main outcome measure was patient-, area-, and hospital-level risk factors for readmission. Secondary outcome measures were the rate of 30-day unplanned readmission and the rate of 30-day mortality. RESULTS We identified 11 394 cases of previously untreated parotid cancer undergoing definitive surgery. The 30-day unplanned readmission rate following parotidectomy was 2.1% (235 of 11 394 surgical procedures). Reported as odds ratios (95% CIs), factors associated with the 30-day unplanned readmission rate on multivariable analysis included advanced pathologic T category (1.59 [1.14-2.20]), uninsured status (2.27 [1.07-4.80]), and increased morbidity as measured by the Charlson/Deyo Score (CDS) (CDS 1, 1.57 [1.05-2.35]; CDS >1, 2.08 [1.06-4.08]). Thirty-day unplanned readmission was associated with an 8.4-fold (8.36 [2.04-34.30]) increased risk of 30-day mortality (1.9% vs 0.2%). CONCLUSIONS AND RELEVANCE Thirty-day unplanned readmission following surgery for parotid cancer is not common. Risk factors associated with 30-day unplanned readmission include pathologic T category, comorbidity, and uninsured status. Having an unplanned 30-day readmission is associated with greater risk of 30-day mortality.

Mucinous Adenocarcinoma of the Salivary Gland: A Review of a Rare Tumor.

Objective To describe the clinical, demographic, and prognostic features of salivary gland mucinous adenocarcinoma, a rare head and neck malignancy. Study Design Population-based national cancer registry analysis. Setting Academic medical center. Subjects and Methods A review was performed with the National Cancer Database from 1998 to 2012. Demographic, clinical, and survival characteristics were compiled and analyzed. Cox multivariate regression was used to identify predictors of survival. Log-rank tests were used to test survival differences unless otherwise specified. Results A total of 170 cases were identified. The most common site of involvement was the parotid gland. Rates of nodal and distant metastases were 45.9% and 10.6%, respectively. High histologic grade was associated with nodal disease (P < .001) and advanced-stage disease (P = .006). Overall 5- and 10-year survival rates were 60% and 44%, respectively. Multivariate analysis found tumor size ≥2 cm (hazard ratio, 22.6; 95% confidence interval: 4.06-126.09; P < .001) and distant metastases (hazard ratio, 17.6; 95% confidence interval: 3.75-82.68; P < .001) to predict poor outcomes. Conclusions Mucinous adenocarcinoma of the salivary gland is a rare otolaryngic cancer. Regional metastases and advanced stage are more common with high histologic grade. Tumor size and distant metastases negatively influence survival.

Predictors of survival in parotid small cell carcinoma: A study of 344 cases.

We sought to better characterize patient, tumor, and long‐term survival characteristics of parotid small cell carcinoma (SmCC) with the National Cancer Database (NCDB).

Predictors of survival in posterior cricoid squamous cell carcinoma: A study of 248 cases

We aimed to describe the presentation, treatment patterns, and survival characteristics of posterior cricoid squamous cell carcinoma (SCC) with the National Cancer Database (NCDB).

Predictors of outcomes in large cell undifferentiated carcinoma of the major salivary glands

Major salivary gland large‐cell undifferentiated carcinoma (LCUC) is rare and has a poor prognosis. Characterization of patient demographics, tumor characteristics, and predictors of outcome have been limited by low case numbers, as well as grouped analysis with other salivary malignancies. The objective of this study was to address these issues using large‐scale national data.