Skip to main content
SpringerLink
Log in

Mortality rates and prognostic factors in patients with malignant salivary tumors

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Malignancies of the salivary glands represent a multifarious disease. Evaluating the prognostic factors of these malignancies may help predict patient outcome and aid decision-making in choosing the most suitable therapy. We examined the role of various salivary tumorigenic, clinical and therapeutic features in a cohort of 101 patients diagnosed and treated for primary malignant salivary tumors. These include histo-pathological diagnosis, stage, grade and T, N, M values as well as the existence of perineural invasion and extra-parenchymal spread. We also identified the salivary gland involved, the sub-compartment specific location of the tumor and the therapy administered. All these were related to mortality. Of the 101 patients examined, 79 survived and 22 died due to the disease. Tumor staging, distant metastasis and perineural invasion were highly significant predictors of increased lethality. Histo-pathological grading was also a predictor but to a lesser degree. Neither neck metastasis nor tumor size or type had a significant impact on lethality. Performing neck dissections did not decrease lethality rate. Location of the tumor in the parotid gland and more so in its deep lobe adversely affected lethality; extra-parenchymal spread also had an adverse effect. Our results seem to indicate hematogenous rather than lymphogenous spread of metastasis from malignant salivary tumors. The highest therapeutic priority should be achieving full local control of the disease by safe removal of the primary salivary tumor, accompanied by regional control of perineural invasion and extra-parenchymal spread and appropriate systemic treatment aimed at eradicating distant metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Spiro RH. Factors affecting survival in salivary gland cancers. In: McGurk M, Renehan A, editors. Controversies in the management of salivary gland disease, Oxford: Oxford University Press; 2001. pp. 143–50.

    Google Scholar 

  2. Speight PM, Barrett AW. Prognostic factors in malignant tumours of the salivary glands. Br J Oral Maxillofac Surg. 2009;47(8):587–93.

    Article  Google Scholar 

  3. McGurk M. Management of salivary gland cancer: clinically or pathologically based? Overview. In: McGurk M, Renehan A, editors. Controversies in the management of salivary gland disease, Oxford: Oxford University Press; 2001. pp. 155–61.

    Google Scholar 

  4. Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Keus RB, Hart AA. Stage as major long term outcome predictor in minor salivary gland carcinoma. Cancer. 2000;89:1195–204.

    Article  CAS  Google Scholar 

  5. Slevin N, Frankenthaler R. The role of radiotherapy in the management of salivary gland cancer. In: McGurk M, Renehan A, editors. Controversies in the management of salivary gland disease, Oxford: Oxford University Press; 2001. pp. 163–72.

    Google Scholar 

  6. Bjørndal K, Krogdahl A, Therkildsen MH, et al. Salivary gland carcinoma in Denmark 1990–2005: a national study of incidence, site and histology. Results of the Danish Head and Neck Cancer Group (DAHANCA). Oral Oncol. 2011;47(7):677–82. https://doi.org/10.1016/j.oraloncology.2011.04.020.

    Article  PubMed  Google Scholar 

  7. Jeannon JP, Calman F, Gleeson M, et al. Management of advanced parotid cancer A systematic review. Eur J Surg Oncol. 2009;35(9):908–15. https://doi.org/10.1016/j.ejso.2008.10.009.

    Article  PubMed  Google Scholar 

  8. Nobis CP, Rohleder NH, Wolff KD, Wagenpfeil S, Scherer EQ, Kesting MR. Head and neck salivary gland carcinomas--elective neck dissection, yes or no? J Oral Maxillofac Surg. 2014;72(1):205-10. https://doi.org/10.1016/j.joms.2013.05.024.

    Article  PubMed  Google Scholar 

  9. Kopeć T, Mikaszewski B, Jackowska J, Waśniewska-Okupniak E, Szyfter W, et al. Treatment of parotid malignancies—10 years of experience. J Oral Maxillofac Surg. 2015;73:1397–402.

    Article  Google Scholar 

  10. Stodulski D, Mikaszewski B, Stankiewicz C. Are all prognostic factors in parotid gland carcinoma well recognized? Eur Arch Otorhinolaryngol. 2012;269:1019–25. https://doi.org/10.1007/s00405-011-1716-6.

    Article  PubMed  Google Scholar 

  11. Barnes L, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumors: pathology and genetics of head and neck tumors, Lyon: IARC Press; 2005.

    Google Scholar 

  12. Walvekar RR, Andrade Filho PA, Seethala RR, et al. Clinicopathologic features as stronger prognostic factors than histology or grade in risk stratification of primary parotid malignancies. Head Neck. 2011;33:225–31.

    Article  Google Scholar 

  13. Sood S, McGurk M, Vaz F. Management of salivary gland tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S142–9.

    Article  CAS  Google Scholar 

  14. Cho JK, Lim BW, Kim EH, et al. Low-grade salivary gland cancers: Treatment outcomes, extent of surgery and indications for postoperative adjuvant radiation therapy. Ann Surg Oncol. 2016;23:4368–75 https://doi.org/10.1245/s10434-016-5353-6.

    Article  PubMed  Google Scholar 

  15. Lubek JE. Head and neck cancer research and support foundations. Oral Maxillofac Surg Clin North Am. 2018;30(4):459-69.

    Article  Google Scholar 

  16. Kinouchi M, Uchida D, Kuribayashi N, Tamatani T, Nagai H, Miyamoto Y. Involvement of miR-518c-5p to growth and metastasis in oral cancer. PLoS One. 2014;9(12):e115936. https://doi.org/10.1371/journal.pone.0115936.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Wang HC, Chiang WF, Huang HH, Shen YY, Chiang HC. Src-homology 2 domain-containing tyrosine phosphatase 2 promotes oral cancer invasion and metastasis. BMC Cancer. 2014;14:442. https://doi.org/10.1186/1471-2407-14-442.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kuo YZ, Tai YH, Lo HI, et al. MiR-99a exerts anti-metastasis through inhibiting myotubularin-related protein 3 expression in oral cancer. Oral Dis. 2014;20(3):e65-75. https://doi.org/10.1111/odi.12133.

    Article  CAS  PubMed  Google Scholar 

  19. Nagler RM, Kerner H, Laufer D, Ben-Eliezer S, Minkov I, Ben-Itzhak O. Squamous cell carcinoma of the tongue: the prevalence and prognostic roles of p53, Bcl-2, c-erbB-2 and apoptotic rate as related to clinical and pathological characteristics in a retrospective study. Cancer Lett. 2002;186(2):137-50.

    Article  CAS  Google Scholar 

  20. Noorlag R, van der Groep P, Leusink FK, et al. Nodal metastasis and survival in oral cancer: Association with protein expression of SLPI, not with LCN2, TACSTD2, or THBS2. Head Neck. 2015;37(8):1130-6.

    Article  Google Scholar 

  21. Pisani P, Ramponi A, Pia F. The deep parotid lymph nodes: an anatomical and oncological study. J Laryngol Otol. 1996;110:148–50.

    Article  CAS  Google Scholar 

  22. McKean ME, Lee K, McGregor IA. The distribution of lymph nodes in and around the parotid gland: an anatomical study. Br J Plast Surg. 1985;38:1–5.

    Article  CAS  Google Scholar 

  23. Olsen KD, Quer M, de Bree R, Vander Poorten V, Rinaldo A, Ferlito A. Deep lobe parotidectomy—why, when, and how? Eur Arch Otorhinolaryngol. 2017;274:4073–8. https://doi.org/10.1007/s00405-017-4767-5.

    Article  PubMed  Google Scholar 

  24. Thom JJ, Moore EJ, Price DL, Kasperbauer JL, Starkman SJ, Olsen KD. The role of total parotidectomy for metastatic cutaneous squamous cell carcinoma and malignant melanoma. JAMA Otolaryngol Head Neck Surg. 2014;140:548–54.

    Article  Google Scholar 

  25. Wertz AP, Durham AB, Malloy KM, Johnson TM, Bradford CR, McLean SA. Total versus superficial parotidectomy for stage III melanoma. Head Neck. 2017;39:1665–70.

    Article  Google Scholar 

  26. Armstrong JG, Harrison LB, Thaler HT, et al. The indications for elective treatment of the neck in cancer of the major salivary glands. Cancer. 1992;69:615–9.

    Article  CAS  Google Scholar 

  27. Olsen KD, Moore EJ. Deep lobe parotidectomy: clinical rationale in the management of primary and metastatic cancer. Eur Arch Otorhinolaryngol. 2014;271:1181–5.

    Article  Google Scholar 

  28. Dwivedi N, Agarwal A, Raj V, Chandra S. Histogenesis of salivary gland neoplasms. Indian J Cancer. 2013;50(4):361-6.

    Article  CAS  Google Scholar 

  29. de Oliveira FA, Duarte EC, Taveira CT, et al. Salivary gland tumor: a review of 599 cases in a Brazilian population. Head Neck Pathol. 2009;3(4):271-5.

    Article  Google Scholar 

  30. Jones AV, Craig GT, Speight PM, Franklin CD. The range and demographics of salivary gland tumours diagnosed in a UK population. Oral Oncol. 2008;44:407–17.

    Article  CAS  Google Scholar 

  31. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L. Major and minor salivary gland tumors. Crit Rev Oncol Hematol. 2010;74(2):134-48. .

    Article  Google Scholar 

  32. Ungureanu LB, Ciobanu D, Danciu M, et al. Epidemiology and pathology of parotid tumors five-year retrospective study. Rev Med Chir Soc Med Nat Iasi. 2014;118(4):1101-7.

    PubMed  Google Scholar 

  33. Nagler RM, Laufer D. Tumors of the major and minor salivary glands: review of 25 years of experience. Anticancer Res. 1997;17(1B):701-7.

    CAS  PubMed  Google Scholar 

  34. Alfieri S, Granata R, Bergamini C, et al. Systemic therapy in metastatic salivary gland carcinomas: A pathology-driven paradigm? Oral Oncol. 2017;66:58-63.

    Article  Google Scholar 

  35. Schmitt NC, Kang H, Sharma A. Salivary duct carcinoma: An aggressive salivary gland malignancy with opportunities for targeted therapy. Oral Oncol. 2017;74:40-8.

    Article  Google Scholar 

  36. Barrett AW, Speight PM. Perineural invasion in adenoid cystic carcinoma of the salivary glands: a valid prognostic indicator? Oral Oncol. 2009;45(11):936-40.

    Article  Google Scholar 

  37. Huyett P, Duvvuri U, Ferris RL, Johnson JT, Schaitkin BM, Kim S. Perineural invasion in parotid gland malignancies. Otolaryngol Head Neck Surg. 2018;158(6):1035-41. https://doi.org/10.1177/0194599817751888.

    Article  PubMed  Google Scholar 

Download references

Funding

Thie study received no funding.

Author information

Author notes

  1. Yair Israel and Adi Rachmiel have contributed equally.

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, 31096, Haifa, Israel

    Yair Israel, Adi Rachmiel & Rafael Nagler

  2. Department of Nuclear Medicine, Rambam Medical Center, Faculty of Medicine, Rappaport Family Institute for Research in the Medical Sciences, Technion - Israel Institute of Technology, 31096, Haifa, Israel

    Konstantin Gourevich

Authors
  1. Yair Israel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adi Rachmiel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Konstantin Gourevich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rafael Nagler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rafael Nagler.

Ethics declarations

Conflicts of interest

The authors declare no conflicts of interest.

Ethical approval

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Israel, Y., Rachmiel, A., Gourevich, K. et al. Mortality rates and prognostic factors in patients with malignant salivary tumors. Med Oncol 36, 65 (2019). https://doi.org/10.1007/s12032-019-1284-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-019-1284-y

Keywords

Search

Navigation