Elsevier

Auris Nasus Larynx

Volume 45, Issue 5, October 2018, Pages 1066-1072
Auris Nasus Larynx

Survival in patients with submandibular gland carcinoma — Results of a multi-institutional retrospective study

https://doi.org/10.1016/j.anl.2018.01.011Get rights and content

Abstract

Objective

Clinical studies demonstrating the prognostic factors in submandibular gland carcinoma are limited because the tumor is relatively rare. The aim of this study was to identify clinical outcomes and prognostic factors in submandibular gland carcinoma.

Methods

The study included 65 patients with submandibular gland carcinoma who underwent initial surgical treatment at the Kyoto University and its affiliated hospitals.

Results

The 3-year overall survival (OS), disease specific survival, locoregional control (LRC), and no distant metastasis (NDM) rates were 74.2%, 74.2%, 90.0%, and 64.8%, respectively. In the current follow-up study, 16 patients died of the disease, 5 patients were alive with recurrence, 43 patients were alive without disease, and 1 patient died of unrelated disease without recurrence. All patients who died of the disease had developed distant metastasis. Based on univariate analysis, tumor grade (high grade) and lymph node metastases (≥N2) were significant prognostic factors for OS and LRC. It also revealed tumor grade (high grade), T classification (≥T3), and lymph node metastases (≥N2) were significant for distant metastasis. Multivariate analysis showed the following significant prognostic factors: lymph node metastases (≥N2) for OS, LRC, and NDM, and high tumor grade for NDM.

Conclusion

Our study suggested death of submandibular gland carcinoma occurred mainly due to distant metastasis. The significant predictors of distant metastasis were lymph node metastases (≥N2) and tumor grade (high grade).

Introduction

Salivary glands comprise the parotid, submandibular, sublingual, and minor glands. The 2005 World Health Organization classification included 24 malignant salivary gland tumors with many subtypes [dataset] [1]. Submandibular gland carcinoma is relatively rare; 7–11% of all primary epithelial salivary gland tumors occur in the submandibular glands, and 41–45% of submandibular gland tumors are malignant [dataset] [1]. Because of the rarity of the tumors, the literature is consequently limited and the information provided to patients is not sufficient. A better understanding of the tumor, including the patient, tumor, and treatment characteristics remains to be established. Although several studies [dataset] [2], [3], [4], [5], [6], [7], [8] have been conducted to reveal the clinical outcomes and prognostic factors of submandibular gland carcinoma, there are only a few reports [dataset] [2], [3], [4], [5], [6] so far that involve more than 50 patients. A multi-institutional study enables us to analyze a relatively large number of patients. The aim of this retrospective study was to update the clinical outcomes and prognostic factors of submandibular gland carcinoma, based on data from multiple centers.

Section snippets

Patients and methods

This study involved 65 patients with previously untreated submandibular gland carcinoma who underwent curative surgery at the Kyoto University and its affiliated hospitals between 2006 and 2015. These included 12 medical centers in Japan: the Kyoto University Graduate School of Medicine, Japanese Red Cross Wakayama Medical Center, Kurashiki Central Hospital, Japanese Red Cross Osaka Hospital, Kobe City Medical Center General Hospital, Kitano Hospital, Tenri Hospital, Shizuoka General Hospital,

Patient characteristics

A total of 77 cases of surgically treated submandibular gland carcinoma were identified. Twelve cases (16%) that presented with distant metastasis at the initial surgery were excluded from the analysis. After exclusion, 65 cases remained for analysis.

Patient, tumor, and treatment characteristics are summarized in Table 1. The mean age was 63.1 years (range, 33–87). A total of 58% of tumors were classified as high-grade malignancy. Table 2 shows the distribution of tumor histology and grade. The

Discussion

Submandibular gland carcinoma is a rare entity, and the literature is limited. The present study has provided a systematic evaluation of the clinical characteristics and treatment outcomes of the tumor.

As the 2005 World Health Organization classification includes 24 malignant salivary gland tumors with several subtypes, there are many histological types [dataset] [1]. In this study, the most frequent histology was adenoid cystic carcinoma, followed by carcinoma ex pleomorphic adenoma, salivary

Conclusion

In summary, we performed a retrospective study based on multi-institutional data to show the prognostic factors of submandibular gland carcinoma. This study suggested death that from the disease occurred mainly due to distant metastasis. The following were significant factors: lymph node metastases (≥N2) were related to OS, LRC, and NDM, and tumor grade (high grade) was related to NDM.

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