Distant Metastases in Patients with Carcinoma of the Major Salivary Glands

Abstract

Background This study aimed to show the incidence of distant metastases (DM) in salivary gland cancer as well as the types of histology most commonly associated with it and to identify factors predictive of DM. Methods The study identified 301 patients who underwent surgery for cancer of the major salivary glands at Memorial Sloan-Kettering Cancer center between 1985 and 2009. Clinical, tumor, and treatment characteristics were recorded. Tumors were categorized as low-, intermediate-, and high-risk pathology based on histologic subtype and grade. Factors predictive of distant recurrence-free probability (DRFP) were determined by uni- and multivariable analyses. Results The primary tumor was parotid in 266 patients (88 %), and 96 tumors (32 %) were clinical T3/T4. For 57 patients (18.9 %), DM developed with a 5-year DRFP of 72.7 %. The most common site of metastasis was the lung (50 %). The clinical predictors were male gender, cT4 stage, cN+ stage, and clinical overall stage. The multivariable analysis of clinical variables showed male gender (p = 0.018), cT4 stage (p < 0.001), and cN+ stage (p = 0.004) to be significant. The pathologic predictors were high-risk and high-grade pathology, vascular invasion, perineural invasion, positive margins, pT4 stage, pN+ stage, and overall stage. The multivariable analysis of pathologic variables showed high-grade pathology (p < 0.001), perineural invasion (p = 0.005), and pN+ stage (p = 0.002) to be significant. Conclusions Distant metastases developed in approximately 20 % of the patients with salivary gland cancer. The most common site of metastases was the lung. The significant predictors of DM were cT4, cN+, male gender, high-grade pathology, perineural invasion, and positive nodal disease.

High‐grade histology as predictor of early distant metastases and decreased disease‐free survival in salivary gland cancer irrespective of tumor subtype

“…In the review by Bradley, it was reported that the rate of distant failure in salivary gland cancer ranges between 20% and 40% with a higher rate in high‐grade tumors. Other retrospective studies on salivary gland cancer also reported a high rate of distant metastasis in high‐grade tumors . Ali et al showed a 5‐year distant failure rate of 18.9% in all patients with salivary gland cancer and of 47.3% in patients with high‐grade tumors.…”

Detection of distant metastasis and prognostic prediction of recurrent salivary gland carcinomas using 18F‐FDG PET/CT

“…A previous study found distant metastases in only seven of 454 (1.5%) patients at initial staging, but the number increased to 95 (20.0%) during the median follow‐up of 100 months (Nam et al., ). Another study suggested that distant metastases were present in 57 of 266 (18.9%) patients with SGC during a median follow‐up of 43 months (Ali et al., ). The most common site for distant metastasis was the lung, with the proportion ranging from 50% to 78%, while metastases in multiple organs were also very common (Ali et al., ; Nam et al., ).…”

“…Prior studies demonstrated risk factors influencing SGC survival, with tumor size, histological grade, N classification, and distant metastases reported as being associated with cancer‐specific survival and OS outcomes (Ali et al., , ; Bussu et al., ; Roh et al., , ). The metastatic potential of SGC differs substantially according to different sites, pathology, and histological grade (Ali et al., ; Cheung, Franzmann, Sola, Pincus, & Koniaris, ; Ko et al., ; Nam et al., ). Of more than 24 different SGC pathologies, adenoid cystic carcinoma and salivary duct carcinoma have high rates of distant metastases.…”

“…Approximately 5% of head and neck malignancies are SGC, and they consist of various histological types, with different metastatic potentials and clinical courses (Eveson, Auclair, Gnepp, & El‐Naggar, ; Pinkston & Cole, ; Suh & Cho, ; Walvekar et al., ). The presence of SGC metastasis is an important prognostic indicator of survival after definitive treatment (Ali et al., ), and a distant metastasis is more likely to occur in SGC than in other types of head and neck cancer, with an occurrence rate of approximately 20% (Ali et al., ). A recurrence may develop over 5 years after the initial treatment for SGC, which has led to the suggestion of a need for a longer follow‐up than with other types of head and neck cancer (Chen, Garcia, Granchi, Johnson, & Eisele, ; Rafla, ).…”

Efficacy and safety of vinorelbine plus cisplatin chemotherapy for patients with recurrent and/or metastatic salivary gland cancer of the head and neck

“…In contrast to other head and neck malignancies in which the common sites of recurrence are the primary site and/or the regional lymph node, salivary gland cancer usually recurs at the primary and/or distant sites . The most common distant metastatic site is the lungs, followed by the bones, liver, or central nervous system . Some patients undergo multiple surgeries, but most usually progress to a point where they are not amenable to surgery .…”