Patterns of Care and Outcomes of Carcinosarcoma of the Major Salivary Glands

Abstract

Objective Carcinosarcoma of the salivary gland is a rare malignant biphasic tumor. The present study investigates the epidemiology and clinical behavior of carcinosarcoma of the major salivary glands using the National Cancer Database (NCDB). Study Design Historical cohort study. Setting NCDB. Methods All tumors were selected between 2004 and 2018. Patient demographics, tumor characteristics, treatments, and survival were analyzed. Cox regression analysis was performed in surgically treated patients. Results We identified 154 patients in the NCDB with carcinosarcoma of the salivary gland. Median age at diagnosis was 66 years (interquartile range, 55-76). Most patients were male (n = 92, 60%). The majority of tumors were in the parotid (n = 122, 79%), followed by submandibular gland (n = 21, 14%). The majority were high grade (n = 93, 95%), and a significant portion had locally advanced disease (pT3-4; n = 65, 62%). Nodal disease was present in more than one-third (n = 35, 36%). The most common treatment was surgery with adjuvant radiotherapy (n = 75, 49%). With a median follow-up of 36 months, the 3-year overall survival was 57.6% (95% CI, 48.7%-68.0%). In univariable analysis, advanced pT stage, pN+ disease, and positive margins were associated with worse survival. In multivariable analysis, age (hazard ratio, 1.02; 95% CI, 1.01-1.04; P = .03) and pT stage (hazard ratio, 2.51; 95% CI, 1.27-4.95; P = .008) remained significant. Conclusion Carcinosarcoma is a rare salivary gland tumor that frequently presents at a locally advanced stage. Despite multimodality treatments, the outcomes are poor. In the absence of clinical trial data, these data from the NCDB could guide clinicians in the management of this rare disease.

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

“…37 Our study confirms the well-documented associations between aRT, reduced risk of recurrence, and improved survival in MSGC. 1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Among patients with ≥1 indication for aRT alone, there was no difference in OS with the addition of adjuvant chemotherapy, but OS was poorer among patients missing aRT. Among patients with ≥1 possible indication for aCRT, aRT alone and aCRT conferred similar survival benefits, but OS was poorer among patients missing aRT.…”

“…Surgical resection is preferred for the definitive treatment of MSGC and several institutional and national studies demonstrate the survival benefit of timely aRT delivered in the presence of high-risk clinicopathologic features. 1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] However, adherence to evidence-based recommendations, a reflection of the quality of care that a treatment facility can provide, is challenging. [50][51][52] Our study investigating adjuvant therapy for MSGC suggests that deviations from evidence-based recommendations in aRT occur frequently and portend poorer OS.…”

Minor Salivary Gland Carcinosarcoma of the Floor of the Mouth

“…Salivary gland carcinosarcoma has a poor prognosis and carcinosarcoma de novo has even worse survival. Distant metastases, higher pT stage, and age are significantly associated with worse prognosis [ 11 , 12 ]. As carcinosarcoma is a rare entity, there is currently no therapeutic protocol that has been established as the gold standard.…”

“…As carcinosarcoma is a rare entity, there is currently no therapeutic protocol that has been established as the gold standard. Several database studies have attempted to evaluate the prognostic factors and treatment options, however, most of the studies are focused on major salivary glands [ 2 , 11 , 12 ]. Treatment may consist of surgery alone or treatment combinations of surgery-radiotherapy and surgery-chemotherapy [ 8 , 12 ].…”

“…Several database studies have attempted to evaluate the prognostic factors and treatment options, however, most of the studies are focused on major salivary glands [ 2 , 11 , 12 ]. Treatment may consist of surgery alone or treatment combinations of surgery-radiotherapy and surgery-chemotherapy [ 8 , 12 ]. Anonsen et al treated the patient with surgery, with no evidence of disease one year after surgery.…”