BACKGROUND: Minor salivary gland carcinomas of the head and neck are rare cancers with variable clinical behavior. This study explored the incidence, pathology, clinical behavior, and factors predictive of outcomes in a large cohort of patients treated at Memorial Sloan Kettering Cancer Center over a 30-year period (1985-2015). METHODS: Clinical, pathological, treatment, and outcome data were collected. Unadjusted and adjusted hazard ratios for each variable were calculated with univariate and multivariable Cox regression for survival and recurrence outcomes. RESULTS: Four hundred fifty patients were included: 55% were female, 56% were younger than 60 years, and the median follow-up was 74 months (range, 1-364 months). The most common site was the oral cavity with 305 tumors (68%), which was followed by the oropharynx with 96 (21%), the sinonasal cavity with 38 (8%), the trachea with 7 (2%), and the larynx with 4 (1%). The most common histological types were mucoepidermoid carcinoma (180 tumors [40%]), adenoid cystic carcinoma (141 tumors [31%]), and polymorphous low-grade adenocarcinoma (54 tumors [12%]). The 5-year predicted overall survival rate was 86%, and the disease-specific survival rate was 94% at 5 years. Pathology and tumor stage were significant variables on multivariate analysis for overall survival, disease-specific survival, recurrence-free survival, local recurrencefree survival, regional recurrence-free survival, and distant recurrence-free survival. CONCLUSIONS: American Joint Committee on Cancer stage and pathology were the most predictive variables across all outcomes. Tumor site, postoperative radiotherapy, and margin status were not statistically significant variables after tumor stage and pathology were controlled for in most outcomes.

Background Inflammation and immune surveillance evasion are cancer hallmarks. Peripheral blood leukocytes (PBLs) represent both. The aim of the current study was to examine PBLs as predictors of outcomes in oral cavity squamous cell carcinoma (OSCC), and to find specific cutoffs with the goal of including PBLs as host factor in patients' preoperative risk assessment. Methods Previously established head and neck squamous cell carcinoma (HNSCC) cutoffs were examined in an independent cohort of 1369 OSCC patients. Then optimal OSCC cutoffs were found and validated in the subset of patients with OSCC (n = 119) from the external HNSCC cohort. The PBLs analyzed were neutrophils, monocytes, and lymphocytes individually, the neutrophil‐to‐lymphocyte ratio (NLR), and a combined index using all PBLs called Systemic Inflammation Response Index (SIRI). Results All parameters were significant predictors of survival using the previous cutoffs. However, OSCC cutoffs stratified survival outcomes better. Considering neutrophils ≤4.8 × 109/L as reference, patients with 4.8–9.1 × 109/L neutrophils had 1.536 times higher risk of death (95% CI, 1.295‐1.822), and patients with ≥9.1 × 109/L had 3.076 times higher risk (95% CI: 2.170‐4.360). All PBLs maintained independent prognostic capacity in multivariable analysis. Neutrophils, NLR, and SIRI were significant predictors of survival when validating OSCC cutoffs in the external validation cohort. Conclusions Pretreatment peripheral blood neutrophils, NLR, and SIRI are the most robust independent predictors of overall survival among all PBLs in OSCC. The authors report externally validated cutoffs that demonstrate the feasibility of including PBLs as host features in the preoperative prognostication of OSCC.

BACKGROUND: Distant metastases (DMs) are the primary cause of treatment failure in patients with salivary gland carcinoma. There is no consensus on the standard treatment. METHODS: Patients with DMs were identified from an institutional database of 884 patients with salivary gland cancer who underwent resection of the primary tumor between 1985 and 2015. Survival outcomes for patients with DMs were determined with the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify factors associated with DM. RESULTS: Of the 884 patients identified, 137 (15%) developed DMs during follow-up. Most of the primary tumors (n = 77 [56%]) were located in a major salivary gland. At clinical presentation, 53% of the tumors were classified as T3 or T4, and 32% had clinical node metastases. The median time to DM was 20.3 months. The factors associated with shorter distant recurrence-free survival were male sex, high-risk tumor histology, and advanced pathological T and N classifications. Patients with bone metastases had a lower survival rate than patients with lung metastases. The total number of DMs in a patient was inversely associated with survival. Patients who underwent surgical resection of DMs had a significantly higher 5-year rate of metastatic disease-specific survival than patients who underwent observation or nonsurgical treatment (44%, 29%, and 19%, respectively; P = .003). CONCLUSIONS: In patients with DMs of salivary gland carcinoma, survival is negatively associated with high-grade histology, bone DMs, and the total number of DMs. Metastasectomy can help to lengthen disease-free survival. Cancer 2020;126:2153-2162.

Background-Multifocality in papillary thyroid carcinoma (PTC) is common. The aim of this study is to determine whether patients with multifocal disease (MFD), treated with lobectomy alone, have an increased risk of contralateral lobe PTC, regional recurrence, and poorer survival.Methods-After institutional review board approval, PTC patients managed, from 1986 to 2015, with lobectomy alone were identified from an institutional database. PTC patients with pT3-T4 classification, nodal disease, or distant metastases were excluded. After excluding 40 patients who underwent an immediate completion thyroidectomy, 849 were included in the analysis; 619 (72.9%) had unifocal disease (UFD), and 230 (27.1%) had MFD.Contralateral lobe PTC-free survival (CLPFS), recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were calculated using the Kaplan-Meier method.Results-With a median follow-up of 58 months, UFD and MFD patients had similar rates of contralateral lobe PTC, regional recurrence and OS (10-year CLPFS 98.6% vs. 97.8%; RFS 99.5% vs. 99.4%; OS 91.6% vs. 93.1%, respectively). There were no disease-related deaths.

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Background: This study aims to evaluate the impact of perioperative fluid administration, defined as fluid delivered intraoperatively and in the postanesthesia care unit, on postoperative outcomes. Methods: Medical records of 102 patients with oral cavity squamous cell carcinoma undergoing free flap reconstruction between January 2011 and December 2015 were reviewed. The primary endpoint was development of a postoperative complication according to the Clavien-Dindo classification. Perioperative factors recorded were Washington University Head and Neck Comorbidity Index, operating time, vasopressor use, blood loss, intraoperative fluid, and perioperative fluid. Results: Greater perioperative fluid administration was independently associated with surgical complications, flap complications, overall incidence of any complication, and increased length of stay. Greater intraoperative fluid administration was independently associated with higher rates of surgical complications. Intraoperative delivery of vasopressors was not associated with flap or surgical complications. Conclusion: Receiving less perioperative fluid was associated with fewer complications and decreased length of stay. K E Y W O R D S free tissue transfer, head and neck cancer, intraoperative fluid, oral cavity squamous cell carcinoma, perioperative fluid, postanesthesia care unit, postoperative complication

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