Abstract
Purpose
To evaluate the role of elective neck dissection (END) and of adjuvant radiation (aRT) in polymorphous adenocarcinoma (PAC), previously known as polymorphous low-grade adenocarcinoma (PLGA).
Methods
Retrospective cohort study of patients in the National Cancer Database with a histology of PAC (coded as PLGA) at a head and neck site diagnosed between 2004 and 2015. Multivariable Cox proportional hazard modeling was used to assess overall survival in the overall population, and in sub-analyses of clinically N0 disease, positive resection margins, and late stage disease.
Results
A total of 922 patients [66.8% female; mean (SD) age, 60.9 (13.9) years] met inclusion criteria. 74.7% of patients received surgery alone, and 18.0% received surgery and aRT. Only 7.6% of patients with clinically N0 disease received an END, with 10.6% of these having at least one positive node. END did not have a survival benefit compared to no END [HR 1.28 (0.61–2.68)]. Compared to surgery alone, aRT did not have significantly increased survival in the overall population or in late stage [HR 0.68 (0.39–1.19) and HR 0.46 (0.18–1.22), respectively]. On sub-analysis of patients with positive resection margins, aRT had a significant survival benefit compared to surgery alone [HR 0.37 (0.14–0.99)].
Conclusion
PAC is a rare, slow-growing malignant tumor typically treated with surgical excision, with undefined indications for END or aRT. Our findings show END to not have a benefit to overall survival. In patients with positive resection margins, there was a survival benefit for aRT.
Similar content being viewed by others
Data availability
The data used for this study were obtained from the National Cancer Database (NCDB). The data must be obtained directly from the Commission on Cancer and cannot be shared between investigators.
References
Evans HL, Batsakis JG (1984) Polymorphous low-grade adenocarcinoma of minor salivary glands: a study of 14 cases of a distinctive neoplasm. Cancer 53(4):935–942. https://doi.org/10.1002/1097-0142(19840215)53:4%3c935::AID-CNCR2820530420%3e3.0.CO;2-V
Seethala RR, Stenman G (2017) Update from the 4th edition of the World Health Organization classification of head and neck tumours: tumors of the salivary gland. Head Neck Pathol 11(1):55–67. https://doi.org/10.1007/s12105-017-0795-0
Tumours of salivary glands (2017) In: El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg P (eds) World Health Organisation classification of head and neck tumours. 4 edn. Lyon IARC press, pp 159–202
Vander Poorten V, Triantafyllou A, Skálová A, Stenman G, Bishop JA, Hauben E, Hunt JL, Hellquist H, Feys S, De Bree R, Mäkitie AA, Quer M, Strojan P, Guntinas-Lichius O, Rinaldo A, Ferlito A (2018) Polymorphous adenocarcinoma of the salivary glands: reappraisal and update. Eur Arch Otorhinolaryngol 275(7):1681–1695. https://doi.org/10.1007/s00405-018-4985-5
Simpson RHW, Reis-Filho JS, Pereira EM, Ribeiro AC, Abdulkadir A (2002) Polymorphous low-grade adenocarcinoma of the salivary glands with transformation to high-grade carcinoma. Histopathology 41(3):250–259. https://doi.org/10.1046/j.1365-2559.2002.01439.x
Evans HL, Luna MA (2000) Polymorphous low-grade adenocarcinoma: a study of 40 cases with long-term follow up and an evaluation of the importance of papillary areas. Am J Surg Pathol 24(10):1319–1328. https://doi.org/10.1097/00000478-200010000-00001
Patel TD, Vazquez A, Marchiano E, Park RC, Baredes S, Eloy JA (2015) Polymorphous low-grade adenocarcinoma of the head and neck: a population-based study of 460 cases. Laryngoscope 125(7):1644–1649. https://doi.org/10.1002/lary.25266
Kimple AJ, Austin GK, Shah RN, Welch CM, Funkhouser WK, Zanation AM, Shockley WW (2014) Polymorphous low-grade adenocarcinoma: a case series and determination of recurrence. Laryngoscope 124(12):2714–2719. https://doi.org/10.1002/lary.24788
Anderson C, Krutchkoff D, Pedersen C, Cartun R, Berman M (1990) Polymorphous low grade adenocarcinoma of minor salivary gland: a clinicopathologic and comparative immunohistochemical study. Mod Pathol 3(1):76–82
Pogodzinski MS, Sabri AN, Lewis JE, Olsen KD (2006) Retrospective study and review of polymorphous low-grade adenocarcinoma. Laryngoscope 116(12):2145–2149. https://doi.org/10.1097/01.mlg.0000243200.35033.2b
González-García R, Rodríguez-Campo FJ, Muñoz-Guerra MF, Nam-Cha SH, Sastre-Pérez J, Naval-Gías L (2005) Polymorphous low-grade adenocarcinoma of the palate: report of cases. Auris Nasus Larynx 32(3):275–280. https://doi.org/10.1016/j.anl.2005.03.019
Seethala RR, Johnson JT, Barnes EL, Myers EN (2010) Polymorphous low-grade adenocarcinoma. Arch Otolaryngol-Head Neck Surg 136(4):385. https://doi.org/10.1001/archoto.2010.39
Mimica X, Katabi N, McGill MR, Hay A, Zanoni DK, Shah JP, Wong RJ, Cohen MA, Patel SG, Ganly I (2019) Polymorphous adenocarcinoma of salivary glands. Oral Oncol 95:52–58. https://doi.org/10.1016/j.oraloncology.2019.06.002
Winchester DP, Stewart AK, Phillips JL, Ward EE (2010) The national cancer data base: past, present, and future. Ann Surg Oncol 17(1):4–7. https://doi.org/10.1245/s10434-009-0771-3
Surgeons ACo (2020) National Cancer Database [database online]
Bilimoria KY, Bentrem DJ, Stewart AK, Winchester DP, Ko CY (2009) Comparison of commission on cancer-approved and –nonapproved hospitals in the United States: implications for studies that use the national cancer data base. J Clin Oncol 27(25):4177–4181. https://doi.org/10.1200/jco.2008.21.7018
Janz TA, Graboyes EM, Nguyen SA, Ellis MA, Neskey DM, Harruff EE, Lentsch EJ (2019) A comparison of the NCDB and SEER database for research involving head and neck cancer. Otolaryngol-Head Neck Surg 160(2):284–294. https://doi.org/10.1177/0194599818792205
D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the charlson comorbidity index with administrative data bases. J Clin Epidemiol 49(12):1429–1433. https://doi.org/10.1016/s0895-4356(96)00271-5
Singh B, Bhaya M, Stern J, Roland JT, Zimbler M, Rosenfeld RM, Har-El G, Lucente FE (1997) Validation of the Charlson comorbidity index in patients with head and neck cancer: a multi-institutional study. Laryngoscope 107(11):1469–1475. https://doi.org/10.1097/00005537-199711000-00009
Carey RM, Godovchik J, Workman AD, Kuan EC, Parasher AK, Chen J, Palmer JN, Adappa ND, Newman JG, Brant JA (2017) Patient, disease, and treatment factors associated with overall survival in esthesioneuroblastoma. Int Forum Allergy Rhinol 7(12):1186–1194. https://doi.org/10.1002/alr.22027
Carey RM, Parasher AK, Workman AD, Yan CH, Glicksman JT, Chen J, Palmer JN, Adappa ND, Newman JG, Brant JA (2018) Disparities in sinonasal squamous cell carcinoma short- and long-term outcomes: analysis from the national cancer database. Laryngoscope 128(3):560–567. https://doi.org/10.1002/lary.26804
Rajasekaran K, Stubbs V, Chen J, Yalamanchi P, Cannady S, Brant J, Newman J (2018) Mucoepidermoid carcinoma of the parotid gland: a National Cancer Database study. Am J Otolaryngol 39(3):321–326. https://doi.org/10.1016/j.amjoto.2018.03.022
Head and Neck Cancers (Version 1.2020). https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed March 26, 2020
Mohanty S, Bilimoria KY (2014) Comparing national cancer registries: the National Cancer Data Base (NCDB) and the surveillance, epidemiology, and end results (SEER) program. J Surg Oncol 109(7):629–630. https://doi.org/10.1002/jso.23568
Brookhart MA, Stürmer T, Glynn RJ, Rassen J, Schneeweiss S (2010) Confounding control in healthcare database research. Med Care 48:S114–S120. https://doi.org/10.1097/mlr.0b013e3181dbebe3
Acknowledgements
All authors declare that they have no relevant conflicts of interest. There has been no significant financial support for this work.
Funding
None for all authors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None for all authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Civantos, A.M., Viswanathan, S., Prasad, A. et al. Role of elective neck dissection and adjuvant radiation therapy in patients with polymorphous adenocarcinoma. Eur Arch Otorhinolaryngol 278, 3459–3466 (2021). https://doi.org/10.1007/s00405-020-06539-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-020-06539-x