2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Original Investigation Research

Epidemiology and Treatment of Malignant Submandibular Gland Tumors

Results Data on 2626patientswith a diagnosis of primary epithelial tu- mor of the submandibular gland from 1973 through 2011 were extracted from the SEER database. A total of 52.9% of patients weremale and47.1%were female ( Table 1 ).Mean (range) age of diagnosiswas61.3 (7-101) years. Atotal of 81.9%of patientswere white, 8.7%wereblack, and9.4%wereother races. Patientspre- sentedwithvarioushistologicalsubtypesofsubmandibulargland Table 1. Patient Demographic and Tumor Characteristics and Treatment Modality Characteristic Value a Age, y Mean (SD) 61.3 (17.0) Median (range) 63 (7-101) Sex, % Male 52.9 Female 47.1 Race, % White 81.9 Black 8.7 Asian 5.5 Pacific Islander 2.8 Native American 0.4 Other/unknown 0.6 Notable histologic subtypes, % Squamous cell carcinoma 18.1 Adenocarcinoma 13.7 Adenoid cystic carcinoma 36.0 Mucoepidermoid carcinoma 16.9 Other/unknown 15.3 Tumor grade, % Low 24.8 High 28.8 Unknown 46.4 Stage at presentation, % I 16.6 II 11.2 III 16.0 IV 20.1 Unknown 36.0 Surgery performed, % Yes 87.4 No 11.8 Unknown 0.7 Radiation therapy, % Yes 57.8 No 40.1 Unknown 2.1 Tumor size, %, cm Mean (SD) 3.0 (2.0) Median 2.5 a Percentages may not sum to 100 because of rounding.

Table 2. Survival Data

Overall Survival

Disease-Specific Survival

Characteristic Median (SE), y All patients Tumor size, cm ≤3

7.1 (0.4)

23.0 (2.5)

12.6 (1.25)

Undefined 4.6 (1.0)

>3

2.8 (0.2)

Stage at presentation I

19.7 (1.9) 15.8 (2.7) 9.5 (1.0) 2.0 (0.2) 1.9 (0.2) 4.2 (0.8) 12.1 (0.8) 9.5 (1.4)

Undefined 26.4 (4.6) Undefined 2.6 (0.3) 2.8 (0.5) Undefined 29.6 (2.9) Undefined

II

III IV

Histologic subtype Squamous cell carcinoma

Adenocarcinoma

Adenoid cystic carcinoma Mucoepidermoid carcinoma

% At 2 y At 5 y

65 54 40

74 67 60

At 10 y

tumor, with themost commonbeing adenoid cystic carcinoma (36.0%), followed by squamous cell carcinoma (18.1%), muco- epidermoid carcinoma (16.9%), andadenocarcinoma (13.7%). A totalof24.8%oftumorswereclassifiedaslow-grademalignancy and 28.8%as high-grademalignancy, whereas for 46.4%of tu- mors thegradewasunknownat the timeof presentation. At pre- sentation,16.6%oftumorswereclassifiedasstageI,11.2%asstage II, 16.0%as stage III, 20.1%as stage IV, and36.0%hadunknown stage. A total of 87.4% of patients were treated with surgery, whereas 57.8%of patients received radiation therapy as part of treatment.Mean(SD)tumorsizeatpresentationwas3.0(2.0)cm, while median tumor size at presentation was 2.5 cm. Kaplan-Meier Analysis Using Kaplan-Meier analysis, 2-year OS and DSS for tumors of the submandibular glandwere determined to be 65%and 74%, 5-year survival was 54% and 67%, and 10-year survival was 40% and 60%, respectively, with median (SE) survival being 7.1 (0.4) years for OS and 23.0 (2.5) years for DSS ( Table 2 ). Kaplan-Meier analysis was also performed for notable histo- logic subtypes, stage at presentation, and tumor size ( Figure , Table 2, and eFigure in the Supplement ). Multivariate Analysis The results of themultivariateCox regressionanalysis ofOS and DSSfortheoverallpopulation,aswellasstratifiedbytumorstage and size, are reported in Table 3 . Table 4 contains multivariate Cox regressionanalysisofOSandDSSbrokendownbyhistologic subtype. Independent correlates of OS andDSS for these differ- entpopulationsincludedageatdiagnosis,sex,grade,stageatpre- sentation, and surgery. Older age at diagnosis, higher grade, and later stage at presentationwere found tohave anegative impact onsurvivalwhereasfemalesexandsurgicalresectionhadaposi- tive impact on survival.

(Reprinted) JAMA Otolaryngology–Head & Neck Surgery October 2015 Volume 141, Number 10

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