Abstract
Purpose
To establish typical clinical and radiological profiles of primary low-grade parotid cancers in order to tailor therapeutic strategy.
Materials and methods
Retrospective study of 57 patients operated on for primary parotid cancer between 2010 and 2021, with review of preoperative MRI and histopathology according to a standardized scoring grid.
Objective
To study prognostic factors and determine the preoperative clinical and radiological profile of low-grade cancers.
Results
Good prognostic factors for specific survival were: staging ≤ cT3 (p = 0.014), absence of adenopathy on cN0 MRI (p < 0.001), superficial lobe location (p = 0.033), pN0 (p < 0.001), absence of capsular rupture (p = 0.004), as well as the absence of peri-tumoral nodules (p = 0.033), intra-parotid adenopathies (p < 0.001), vascular emboli (p < 0.001), peri-neural sheathing (p = 0.016), nuclear atypia (p = 0.031), and necrosis (p = 0.002). It was not possible to define a reliable clinical and radiological profile for low-grade cancers (sensitivity 38%, specificity 79%).
Conclusion
Our study demonstrated multiple factors of good prognosis, but it was not possible to define a clinical and radiological profile of patients likely to benefit from more limited surgery, nor to diagnose, a priori, low-grade cancers.
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Appendices
Appendices
Appendix 1: Abbreviations of histological types
Abbreviation | Meaning |
|---|---|
NET | Neuroendocrine tumor |
MEC | Mucoepidermoid carcinoma |
CAK | Adenoid cystic carcinoma |
ACC | Acinar cell carcinoma |
EMC | Epithelial–myoepithelial carcinoma |
MeC | Myoepithelial carcinoma |
SCC | Squamous cell carcinoma |
BCC | Basal cell carcinoma |
ADK | SAI adenocarcinoma (no other indication) |
PEC | Pleomorphic ex-adenoma carcinoma |
sCC | Small cell carcinoma (high-grade neuroendocrine carcinoma) |
Appendix 2: MRI review grid
MRI review grid | |||||
|---|---|---|---|---|---|
cT | 1 | 2 | 3 | 4a | 4b |
Sectors | I | II | III | IV | V |
Capsule | Present | Absent | |||
Size (mm) | Continuous value starting from 0 | ||||
ADC | ≤ 1 | > 1 | |||
Lymph nodes | N0 | N+ | |||
Observation | 1 | 2 | 3 | ||
Appendix 3: Prognostic factors for the absence recurrence at 2 years
Prognostic factors for the absence of recurrence at 2 years | |||
|---|---|---|---|
No recurrence N = 231 | Recurrence N = 91 | p-value2 | |
Gender | 0.427 | ||
Male | 8 (61.5%) | 5 (38.5%) | |
Female | 15 (78.9%) | 4 (21.1%) | |
Age | > 0.999 | ||
≤ 60 years | 12 (75.0%) | 4 (25.0%) | |
> 60 years | 11 (68.8%) | 5 (31.2%) | |
cT3 | 0.002 | ||
≤ cT3 | 18 (90.0%) | 2 (10.0%) | |
> cT3 | 3 (30.0%) | 7 (70.0%) | |
cN | 0.195 | ||
cN0 | 21 (75.0%) | 7 (25.0%) | |
cN+ | 1 (33.3%) | 2 (66.7%) | |
Localization | 0.044 | ||
Superficial parotid | 13 (92.9%) | 1 (7.1%) | |
Deep parotid | 10 (55.6%) | 8 (44.4%) | |
Facial paralysis | 0.021 | ||
Absent | 21 (77.8%) | 6 (22.2%) | |
Present | 0 (0.0%) | 3 (100.0%) | |
Pain | 0.025 | ||
Absent | 15 (88.2%) | 2 (11.8%) | |
Present | 4 (40.0%) | 6 (60.0%) | |
Limited tumor on MRI | 0.432 | ||
Yes | 7 (58.3%) | 5 (41.7%) | |
No | 12 (75.0%) | 4 (25.0%) | |
Mean-ADC | 0.393 | ||
≤ 1 | 6 (60.0%) | 4 (40.0%) | |
> 1 | 11 (78.6%) | 3 (21.4%) | |
pT | < 0.001 | ||
≤ pT2 | 19 (95.0%) | 1 (5.0%) | |
> pT2 | 3 (27.3%) | 8 (72.7%) | |
Histological grade | 0.013 | ||
Low | 11 (100.0%) | 0 (0.0%) | |
High | 12 (57.1%) | 9 (42.9%) | |
Surgical margins | 0.599 | ||
R0 | 42 (85.7%) | 7 (14.3%) | |
R1 | 6 (75.0%) | 2 (25.0%) | |
Capsular rupture | 0.004 | ||
≤ 3 | 16 (94.1%) | 1 (5.9%) | |
> 3 | 6 (42.9%) | 8 (57.1%) | |
Tumor limits | 0.004 | ||
≤ 3 | 16 (94.1%) | 1 (5.9%) | |
> 3 | 6 (42.9%) | 8 (57.1%) | |
Distant tumor nodules | 0.003 | ||
≤ 3 | 19 (90.5%) | 2 (9.5%) | |
> 3 | 4 (36.4%) | 7 (63.6%) | |
Intra-parotid lymph nodes | 0.010 | ||
≤ 2 | 21 (84.0%) | 4 (16.0%) | |
> 2 | 2 (28.6%) | 5 (71.4%) | |
Vascular emboli | 0.006 | ||
Absent | 18 (90.0%) | 2 (10.0%) | |
Present | 5 (41.7%) | 7 (58.3%) | |
Perineural infiltration | 0.113 | ||
Absent | 14 (87.5%) | 2 (12.5%) | |
Present | 9 (56.2%) | 7 (43.8%) | |
Nuclear atypia | 0.002 | ||
Absent | 14 (100.0%) | 0 (0.0%) | |
Present | 9 (50.0%) | 9 (50.0%) | |
Necrosis | 0.015 | ||
Absent | 17 (89.5%) | 2 (10.5%) | |
Present | 6 (46.2%) | 7 (53.8%) | |
pN | 42 (89.4%) | 0.076 | |
pN0 | 20 (80.0%) | 5 (20.0%) | |
pN+ | 3 (42.9%) | 4 (57.1%) | |
Appendix 4: Low- and high-grade profiles comparison in the sub-population of 32 patients
Low grade N = 171 | High grade N = 151 | p-value | |
|---|---|---|---|
Gender | 0.9072 | ||
Male | 6 (35.3%) | 5 (33.3%) | |
Female | 11 (64.7%) | 10 (66.7%) | |
Age | |||
< 55 years | 10 (58.8%) | 10 (58.8%) | 0.0672 |
≥ 55 years | 7 (41.2%) | 11 (73.3%) | |
Facial paralysis | |||
Absent | 16 (100.0%) | 14 (100.0%) | |
Pain | 0.1483 | ||
Absent | 13 (92.9%) | 8 (66.7%) | |
Present | 1 (7.1%) | 4 (33.3%) | |
cT | 0.432 | ||
≤ cT2 | 9 (52.9%) | 10 (66.7%) | |
> cT2 | 8 (47.1%) | 5 (33.3%) | |
Mean-ADC | 0.5472 | ||
< 1 | 6 (35.3%) | 6 (46.2%) | |
≥ 1 | 11 (64.7%) | 7 (53.8%) | |
Encapsulated on MRI | 0.2433 | ||
Yes | 3 (17.6%) | 6 (40.0%) | |
No | 14 (82.4%) | 9 (60.0%) | |
Localization | > 0.9992 | ||
Superficial parotid | 13 (76.5%) | 12 (80.0%) | |
Deep parotid | 4 (23.5%) | 3 (20.0%) | |
Appendix 5: Results of clinico-radiological concordance with histology for the sub-population of 32 patients
Post-operative | |||
|---|---|---|---|
Low grade without poor prognostic factors N = 13 | High grade and/or poor prognostic factors N = 19 | ||
Pre-operative | |||
Criteria in favor of low-grade N = 9 | 5 | 4 | PPV = 55% |
Criteria in favor of high-grade N = 23 | 8 | 15 | NPV = 65% |
Sensitivity = 38% | Specificity = 79% | ||
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Ghenni, S., Del Grande, J., Gravier Dumonceau, R. et al. Parotid cancer: analysis of preoperative parameters for adaptation of the therapeutic strategy. Eur Arch Otorhinolaryngol 281, 3207–3218 (2024). https://doi.org/10.1007/s00405-024-08607-y
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DOI: https://doi.org/10.1007/s00405-024-08607-y