Affiliation:
1. Department of Otorhinolaryngology–Head & Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA
2. Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
Abstract
AbstractObjectiveWe aim to evaluate the role of elective neck dissection (END) and adjuvant radiation on survival in N0 high‐grade mucoepidermoid carcinoma (MEC).Study DesignRetrospective cohort study.SettingNational Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.MethodsAll patients diagnosed with high‐grade MEC with node‐negative disease (N0) from 2004 to 2018 were included. Demographic, clinicopathologic, treatment, and outcomes were analyzed. Kaplan‐Meier survival curves were used to evaluate 5‐year disease‐specific survival (DSS) and 5‐year overall survival (OS). Multivariate Cox regression analysis was used to control for confounders.ResultsA total of 310 patients with high‐grade MEC and N0 (clinical and pathologic) disease were identified. The parotid was the most common primary site (266, 86%). Of included patients, 133 (42.9%) were T3‐T4 tumors and 212 (68%) received adjuvant radiation. END was performed on 223 (71.9%) of cases. END in T3‐T4 high‐grade MEC led to significant improvements in DSS (74.3% vs 34.0%, P < .01) and OS (55.2% vs 20.5%, P < .01) as compared to no END. Subanalysis shows that in patients who received neck dissections and were pathologic N0, adjuvant radiation had no impact on DSS (84.0% vs 72.1%, P = .45) and OS (52.1% vs 55.8%, P = .91). Benefits persisted when controlling for confounders using multivariate Cox proportional regression.ConclusionPatients with T3‐T4 high‐grade MEC who underwent END and found to be pathologically node‐negative (pN0) had significantly improved 5‐year DSS and 5‐year OS than patients who were cN0 and did not undergo END. Importantly, although 68% of patients received adjuvant radiation, we show no benefit of this treatment modality on outcomes in pN0 high‐grade MEC.