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Otolaryngol Head Neck Surg. 2019 Jun;160(6):1048-1057. doi: 10.1177/0194599819827851. Epub 2019 Feb 5.

Survival Impact of Adjuvant Therapy in Salivary Gland Cancers following Resection and Neck Dissection.

Author information

1
1 Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
2
2 Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
3
3 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
4
4 Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California, USA.
5
5 Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
6
6 Institute of Biomedicine, Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland.

Abstract

OBJECTIVE:

To evaluate the impact of postoperative radiotherapy (PORT) and chemotherapy on survival in salivary gland cancer (SGC) treated with curative-intent local resection and neck dissection.

STUDY DESIGN:

Retrospective population-based cohort study.

SETTING:

National Cancer Database.

SUBJECTS AND METHODS:

Patients with SGC who were undergoing surgery were identified from the National Cancer Database between 2004 and 2013. Neck dissection removing a minimum of 10 lymph nodes was required. Because PORT violated the proportional hazards assumption, this variable was treated as a time-dependent covariate.

RESULTS:

Overall, 4145 cases met inclusion criteria (median follow-up, 54 months). PORT was associated with improved overall survival in multivariable analysis, both ≤9 months from diagnosis (hazard ratio [HR], 0.26; 95% CI, 0.20-0.34; P < .001) and >9 months (HR, 0.75; 95% CI, 0.66-0.86; P < .001). In propensity score-matched cohorts, 5-year overall survival was 67.1% and 60.6% with PORT and observation, respectively ( P < .001). Similar results were observed in landmark analysis of patients surviving at least 6 months following diagnosis. Adjuvant chemotherapy was not associated with improved survival (HR, 1.15; 95% CI, 0.99-1.34; P = .06).

CONCLUSION:

PORT, but not chemotherapy, is associated with improved survival among patients with SGC for whom neck dissection was deemed necessary. These results are not applicable to low-risk SGCs not requiring neck dissection.

KEYWORDS:

metastasis; radiotherapy; salivary gland cancer; survival

PMID:
30721113
DOI:
10.1177/0194599819827851

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