Predictive index for lymph node management of major salivary gland cancer

Authors

  • Yu-Long Wang MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Duan-Shu Li MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Hua-Lei Gan MD,

    1. Department of Pathology, Department of Radiation, Cancer HospitalFudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Zhong-Wu Lu MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Hui Li MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Guo-Pei Zhu MD,

    1. Department of OncologyFudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Cai-Ping Huang MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Yong-Xue Zhu MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Tong-Zhen Chen MD,

    1. Department of Pathology, Department of Radiation, Cancer HospitalFudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Yu Wang MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Guo-Hua Sun MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Zhuo-Ying Wang MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Qiang Shen MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Yi Wu MD,

    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    Search for more papers by this author
  • Qing-Hai Ji MD

    Corresponding author
    1. Department of Head and Neck Surgery, Fudan University, Shanghai, China
    2. Shanghai Medical College , Fudan University, Shanghai, China
    • Department of Head and Neck Surgery, Cancer Hospital, Fudan University, 270 Dong'an Road, Shanghai 200032, China
    Search for more papers by this author

  • Presented in part at the 4th World Congress of the International Federation of Head and Neck Oncologic Societies (IFHNOS 2010), Seoul, South Korea, June 15–19, 2010.

  • Yu-Long Wang and Qing-Hai Ji were supported by National Science Foundation of China (30872958, 81001204). The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To find the risk factors of lymph node (LN) metastasis of salivary gland cancer and draw a scheme for LN management.

Study Design:

Hospital-based retrospective study.

Methods:

The records of salivary gland cancer patients treated at the Department of Head and Neck Surgery, Cancer Hospital, Fudan University, were entered in a database, and 219 consecutive patients with carcinomas of major salivary glands primarily operated on between January 1998 and January 2011 were chosen for univariate and multivariate analysis to identify risk factors for LN involvement.

Results:

Fifty-eight (26.5%) patients had LN involvement. Factors associated with cervical LN involvement on univariate analysis included pathologic type, male sex, shorter duration of preoperative course, facial paralysis, advanced T stage, and major nerve, soft tissue, lymphatic/vascular (L/V), neural/perineural, and extracapsular invasion. Multivariate analysis identified major nerve invasion, histologic type, L/V invasion, and extracapsular invasion as significant factors for LN involvement. The proportion of patients with LN involvement with low (105), middle (61), high (34), and super high (19) predictive index scores based on the four risk factors were 3.8%, 27.9%, 55.9%, and 94.7%, respectively.

Conclusions:

A predictive index using the clinicopathologic factors described in this report can effectively stratify patients into risk groups for nodal metastasis. Comprehensive management based on this risk index should improve treatment outcomes for patients with salivary gland cancer.

Ancillary