Oncologic Safety of Close Margins in Patients With Low- to Intermediate-Grade Major Salivary Gland Carcinoma-Reference-Cited by-同舟云学术

Oncologic Safety of Close Margins in Patients With Low- to Intermediate-Grade Major Salivary Gland Carcinoma

Published:2023-12-14 Issue: Volume: Page:
ISSN:2168-6181
Container-title:JAMA Otolaryngology–Head & Neck Surgery
language:en
Short-container-title:JAMA Otolaryngol Head Neck Surg

Author:

Sajisevi Mirabelle¹,Nguyen Kenny²,Callas Peter²,Holcomb Andrew J.³,Vural Emre⁴,Davis Kyle P.⁵,Thomas Carissa M.⁶,Plonowska-Hirschfeld Karolina A.⁷,Stein John S.⁶,Eskander Antoine⁸⁹,Kakarala Kiran¹⁰,Enepekides Danny J.⁸,Hier Michael P.¹¹,Ryan William R.⁷,Asarkar Ameya A.¹²,Aulet Ricardo¹³,Bell Rebecca K.¹⁴,Blasco Michael A.¹⁵,Bowmaster Vanessa B.¹⁶,Burruss Clayton P.¹⁷,Chung Jeffson¹⁸,Chan Kimberly¹⁹,Chang Brent A.²⁰,Coffey Charles S.²¹,Cognetti David M.²²,Cooper Dylan J.¹⁵,Cordero Joehassin²³,Donovan John²⁴,Du Yue (Jennifer)²⁵,Dundar Yusuf²³,Dedivitis Rogerio A.²⁶,Edwards Heather A.²⁷,Erovic Boban M.²⁸,Feinberg Philip A.²⁹,Garvey Emily A.³⁰,Goldstein David P.³¹,Goodman Joseph F.³²,Goulart Rafael N.³³,Goyal Neerav¹⁹,Grasl Stefan³⁴,Giurintano Jonathan P.³⁵,Gupta Nikita¹⁷,Habib Andy M.³⁵,Hackman Trevor G.³⁶,Hara Jared H.³⁷,Henson Christina³⁸,Hinni Michael L.²⁰,Hua Nadia³⁹,Johnson-Obaseki Stephanie³⁹,Juloori Aditya³⁷,Kalman Noah S.⁴⁰,Kejner Alexandra E.⁴¹,Khaja Sobia F.⁴²,Ku Jamie A.⁴³,Lambert Arnaud⁴⁴,Luu Bao K.²¹,Magliocca Kelly R.⁴⁵,dos Santos Luiz R. Medina³³,Michael Cara²⁷,Miles Brett A.¹⁵,de Melo Giulianno Molina⁴⁶⁴⁷,Moore Michael G.⁴⁸,Morand Gregoire B.⁴⁴,Moura Kauê⁴⁹,Mukdad Laith⁵⁰,Noroozi Hesameddin³¹,Patel Rusha⁵¹,Paydarfar Joseph A.¹⁴,Sadeghi Nader⁴⁴,Savaria Fabrice N.⁵²,Schmitt Nicole C.⁵³,Shapiro Justin⁵⁴,Shaver Timothy B.³²,Stoeckli Sandro J.⁵²,St. John Maie⁵⁰,Stokes William Alvo¹⁸,Sulibhavi Anita⁵⁵,Tasoulas Jason³⁶,Vendra Varun⁵⁵,Vinh Daniel B.⁴⁸,Virgen Celina G.¹⁰,Wooten Christian⁵⁰,Woody Neil M.⁵⁶,Young Geoffrey D.⁴⁰,

Affiliation:

1. Division of Otolaryngology, University of Vermont Medical Center, Burlington

2. Robert Larner College of Medicine, University of Vermont, Burlington

3. Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha

4. Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock

5. Department of Otolaryngology, St Louis University School of Medicine, St Louis, Missouri

6. Department of Otolaryngology, University of Alabama at Birmingham

7. Department of Otolaryngology, University of California, San Francisco

8. Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada

9. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

10. Department of Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City

11. Otolaryngology–Head and Neck Surgery, Jewish General Hospital, Montreal, Québec, Canada

12. Department of Otolaryngology/Head & Neck Surgery, Ochsner-LSU Health, Shreveport, Louisiana

13. Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts

14. Geisel School of Medicine at Dartmouth, Section of Otolaryngology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire

15. Department of Otolaryngology, Donald and Barbara Zucker School of Medicine/Northwell, Northwell Health Cancer Institute, New York, New York

16. University of Nebraska College of Medicine, Omaha

17. University of Kentucky, Department of Otolaryngology–Head and Neck Surgery, Lexington

18. Department of Otolaryngology–Head & Neck Surgery, West Virginia University, Morgantown

19. Department of Otolaryngology Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania

20. Department of Otolaryngology–Head & Neck Surgery, Mayo Clinic Arizona, Phoenix

21. Department of Otolaryngology/Head & Neck Surgery, University of California San Diego School of Medicine

22. Department of Otolaryngology–Head & Neck Surgery, Sidney Kimmel Medical College/Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania

23. Department of Otolaryngology and Head & Neck Surgery, Texas Tech University - Health Sciences Center, Lubbock

24. Salem Hospital, Salem, Oregon

25. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

26. Department of Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil

27. Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts

28. Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria

29. Medical Scientist Training Program, UMass Chan Medical School, Worcester, Massachusetts

30. Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

31. Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada

32. Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC

33. Hospital Governador Celso Ramos, Florianopolis, Brazil

34. Department of Otorhinolaryngology–Head and Neck Surgery, Medical University of Vienna, Vienna, Austria

35. Department of Otolaryngology, Georgetown, Washington, DC

36. Department of Otolaryngology/Head & Neck Surgery, The University of North Carolina at Chapel Hill

37. Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois

38. Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City

39. Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada

40. Miami Cancer Institute, Baptist Health South Florida and the Herbert Wertheim College of Medicine, Florida International University, Miami

41. Department of Otolaryngology, Medical University of South Carolina, Charleston

42. Department of Otolaryngology, University of Minnesota, Minneapolis

43. Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio

44. Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Québec, Canada

45. Department of Pathology and Laboratory Medicine, Winship Cancer Institute at Emory University, Atlanta, Georgia

46. Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo - UNIFESP/EPM, São Paulo, Brazil

47. Department of Head and Neck Surgery, Beneficência Portuguesa of São Paulo Hospital, São Paulo, Brazil

48. Department of Otolaryngology, University of Indiana, Indianapolis, Indiana

49. Department of Head and Neck Surgery, Santa Casa de Misericórdia de Santos, Santos, Brazil

50. Department of Otolaryngology, University of California, Los Angeles

51. Department of Otolaryngology, University of Oklahoma, Oklahoma City

52. Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St Gallen, St Gallen, Switzerland

53. Department of Otolaryngology, Winship Cancer Institute at Emory University, Atlanta, Georgia

54. Department of Otolaryngology–Head & Neck Surgery, Western University, London, Ontario, Canada

55. Department of Otolaryngology, Temple University Hospital, Philadelphia, Pennsylvania

56. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio

Abstract

ImportancePostoperative radiation therapy for close surgical margins in low- to intermediate-grade salivary carcinomas lacks multi-institutional supportive evidence.ObjectiveTo evaluate the oncologic outcomes for low- and intermediate-grade salivary carcinomas with close and positive margins.Design, Setting, and ParticipantsThe American Head and Neck Society Salivary Gland Section conducted a retrospective cohort study from 2010 to 2019 at 41 centers. Margins were classified as R0 (negative), R1 (microscopically positive), or R2 (macroscopically positive). R0 margins were subclassified into clear (&gt;1 mm) or close (≤1 mm). Data analysis was performed from June to October 2023.Main Outcomes and MeasuresMain outcomes were risk factors for local recurrence.ResultsA total of 865 patients (median [IQR] age at surgery, 56 [43-66] years; 553 female individuals [64%] and 312 male individuals [36%]) were included. Of these, 801 (93%) had parotid carcinoma and 64 (7%) had submandibular gland carcinoma, and 748 (86%) had low-grade tumors and 117 (14%) had intermediate-grade tumors, with the following surgical margins: R0 in 673 (78%), R1 in 168 (19%), and R2 in 24 (3%). Close margins were found in 395 of 499 patients with R0 margins (79%), for whom margin distances were measured. A total of 305 patients (35%) underwent postoperative radiation therapy. Of all 865 patients, 35 (4%) had local recurrence with a median (IQR) follow-up of 35.3 (13.9-59.1) months. In patients with close margins as the sole risk factor for recurrence, the local recurrence rates were similar between those who underwent postoperative radiation therapy (0 of 46) or observation (4 of 165 [2%]). Patients with clear margins (n = 104) had no recurrences. The local recurrence rate in patients with R1 or R2 margins was better in those irradiated (2 of 128 [2%]) compared to observed (13 of 64 [20%]) (hazard ratio [HR], 0.05; 95% CI, 0.01-0.24). Multivariable analysis for local recurrence found the following independent factors: age at diagnosis (HR for a 10-year increase in age, 1.33; 95% CI, 1.06-1.67), R1 vs R0 (HR, 5.21; 95% CI, 2.58-10.54), lymphovascular invasion (HR, 4.47; 95% CI, 1.43-13.99), and postoperative radiation therapy (HR, 0.10; 95% CI, 0.04-0.29). The 3-year local recurrence-free survivals for the study population were 96% vs 97% in the close margin group.Conclusions and RelevanceIn this cohort study of patients with low- and intermediate-grade major salivary gland carcinoma, postoperative radiation therapy for positive margins was associated with decreased risk of local recurrence. In isolation from other risk factors for local recurrence, select patients with close surgical margins (≤1 mm) may safely be considered for observation.

Publisher

American Medical Association (AMA)

Subject

Otorhinolaryngology,Surgery

Link

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/2812465/jamaotolaryngology_sajisevi_2023_oi_230085_1700674304.76207.pdf

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