Carcinoma ex pleomorphic adenoma: A review of incidence, demographics, risk factors, and survival

Gupta, Ashish; Koochakzadeh, Sina; Neskey, David M.; Nguyen, Shaun A.; Lentsch, Eric J.

doi:10.1016/j.amjoto.2019.102279

Cited by 41 publications

(48 citation statements)

References 16 publications

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“…When compared to patients with benign rPA, patients with cxPA were older and more likely to be older than 50. This is compatible with the previous studies describing the average age of patients with cxPA to be around 50 to 60 years old 18,20,21 . In Egal et al, de novo cxPAs were compared to PAs, and age was significantly correlated with the risk of malignant transformation 21 .…”

Section: Discussionsupporting

confidence: 91%

“…On the other hand, the high rate we observed may also be a reflection of improved detection and surveillance of both PAs and cxPAs. In a recent study using the SEER database, the incidence of cxPA was found to have increased 163% from 2005 to 2015, 18 although this rising rate includes both de novo cxPA and cases of cxPA arising from rPA as described in this study. If patients are presenting earlier for treatment of primary PAs—before the lesion undergoes malignant transformation, this may further skew the burden of disease away from de novo cases of cxPA and toward cases of cxPA discovered in rPA.…”

Section: Discussionmentioning

confidence: 59%

“…This is compatible with the previous studies describing the average age of patients with cxPA to be around 50 to 60 years old. 18,20,21 In Egal et al, de novo cxPAs were compared to PAs, and age was significantly correlated with the risk of malignant transformation. 21 In their cohort, the risk of cxPA in patients under age 40 was less than 1%, compared to a risk of >16% in patients over age 60.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma

et al. 2020

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Background: In patients presenting with recurrent pleomorphic adenoma (rPA), clinical evaluation can fail to recognize carcinoma ex PA (cxPA). We aim to identify the risk factors for cxPA. Methods: This is a single institution retrospective case-control study from 2000 to 2015. CxPA was diagnosed based on surgical pathology. Demographics, clinical, and social histories were collected. Results: A number of 13/106 (12.3%) patients were diagnosed with cxPA, of which only 4/13 (31%) had clinical features suspicious for malignancy. Compared to benign rPA, factors associated with cxPA included age >50 (odds ratio [OR] 6.67, 95% confidence interval [CI]: 1.71-25.98, P < .01), >10 pack-years of smoking history (OR 3.36, 95% CI: 1.01-11.14, P = .04), and the largest tumor being >2 cm on pathology (OR 4.42, 95% CI: 1.14-17.10, P = .03). Conclusions: In patients presenting with rPA, risk factors for malignant transformation include age >50, significant smoking history, and tumors larger than 2 cm. Clinical signs of malignancy such as rapid growth or pain are not always present.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma

et al. 2020

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“…Previous reports have investigated factors associated with prolonged survival in patients with CXPA. An analysis of the Surveillance, Epidemiology, and End Results (SEER) database revealed that tumor size more than 4 cm, multiple positive lymph nodes, and distant metastatic disease were associated with increased mortality 15 . An NCDB review of parotid malignancies demonstrated that locally advanced tumors and high‐grade lesions were predictive of nodal metastasis for both CXPA and adenocarcinoma 16 .…”

Section: Discussionmentioning

confidence: 99%

“…increased mortality. 15 An NCDB review of parotid malignancies demonstrated that locally advanced tumors and high-grade lesions were predictive of nodal metastasis for both CXPA and adenocarcinoma. 16 They described a similar rate of occult disease for CXPA (11.8%) and adenocarcinoma (19.9%).…”

Section: Methodsmentioning

confidence: 99%

Outcomes of carcinoma ex pleomorphic adenoma compared to de novo adenocarcinoma of major salivary glands

Patel

Oliver

Liu

et al. 2020

Journal of Surgical Oncology

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Background and ObjectivesCarcinoma ex pleomorphic adenoma (CXPA) is a rare disease of the major salivary glands that remains poorly characterized. Our objective was to compare the clinical outcomes of patients with CXPA of the major salivary glands to those with de novo adenocarcinomas.MethodsReview of the NCDB between 2004 and 2016 to compare cases of CXPA and adenocarcinoma of major salivary glands. Demographics, clinical characteristics, and survival were analyzed.ResultsWe identified 1181 patients with CXPA and 3326 patients with adenocarcinoma of major salivary glands. Adenocarcinomas presented with higher rates of nodal metastasis (54.7% vs. 30.4%, p < .001). Five‐year survival of adenocarcinoma (55.8%) was worse than that of CXPA (68.5%, p < .001). When stratified by nodal status, there was no significant difference in 5‐year survival between CXPA and adenocarcinoma node‐negative (75.3% vs. 71.6%, respectively) and node‐positive (40.4% vs. 36.1%, respectively) patients.ConclusionsCXPAs of the major salivary glands present at an earlier stage with lower rates of regional metastasis compared to adenocarcinomas. After controlling for lymph node metastases, the outcomes are quite similar.

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Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults

Kligerman

Jin

Ayoub

et al. 2020

JAMA Otolaryngol Head Neck Surg

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leomorphic adenoma, a slow-growing, benign salivary gland tumor with incidence rates between 2.4 and 4.9 per 100 000 persons per year, is the most common salivary gland tumor. 1,2 The current mainstay of treatment for pleomorphic adenoma is surgical excision. 1 However, parotidectomy is associated with significant risk of complications. The rate of permanent facial nerve injury after parotidectomy, for instance, is up to 26% according to a meta-analysis. 3 Other less serious but still common adverse effects of parotidectomy include risks of Frey syndrome, first bite syndrome, and skin hypo-anesthesia. 4 It is also important to consider the perioperative risk of general anesthesia. Consequently, the risk of complications should be considered when recommending surgery. Some of the reasons for recommending parotidectomy include correction of cosmetic deformity caused by a tumor, diagnosis and treatment of potential missed malignant neoplasms, and prevention of malignant transformation.Pleomorphic adenoma is associated with an estimated 1.5% risk of malignant transformation to carcinoma ex pleomorphic adenoma within the first 5 years of diagnosis if left untreated. 5 This risk may increase to 10% if left untreated for more than 15 years. 5 Although the risk of malignant transformation is low, it is substantial for younger patients owing to their longer life expectancy and justifies surgery. However, many patients who receive a diagnosis of pleomorphic adenoma late in life may never develop malignant transformation, and surgery may be associated with unnecessary risk.To our knowledge, there is no consensus regarding optimal management of pleomorphic adenoma in adults. Furthermore, it is unclear at what age parotidectomy ceases to be beneficial for elderly patients with pleomorphic adenoma. This decision analytical model compared parotidectomy with observation for the management of pleomorphic adenoma in adults 50 years or older. The study was intended to support IMPORTANCE There is no consensus regarding optimal management of pleomorphic adenoma in adults.OBJECTIVES To compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age.DESIGN AND SETTING This decision analytical model was performed from November 21, 2019, to June 15, 2020, using a Markov model. Model variables and ranges were selected based on a literature review. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each algorithm, either upfront elective parotidectomy or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis using variable ranges was then performed 5 times with patients in the model assigned a starting age of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would be associated with the model results.MAIN OUTCOMES AND MEASURES Model outcomes were measured with quality-adjusted life-years (QALYs). RESULTSIn the study models, the age thresholds at which observation became more beneficial than parotidectomy were 88.5 years f...

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Carcinoma ex pleomorphic adenoma: A review of incidence, demographics, risk factors, and survival

Cited by 41 publications

References 16 publications

Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma

Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma

Outcomes of carcinoma ex pleomorphic adenoma compared to de novo adenocarcinoma of major salivary glands

Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults

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