Guzy ślinianki przyusznej

Guzy ślinianki przyusznej
Rokowania, prognozy i postęp choroby

Rokowanie w guzach ślinianki przyusznej jest silnie uzależnione od histologii, stopnia zaawansowania klinicznego oraz zastosowanego leczenia. Całkowity wskaźnik 5-letniego przeżycia wynosi około 62%, natomiast w przypadku choroby nawrotowej spada do 37%. Wskaźniki przeżycia różnią się w zależności od stadium zaawansowania: dla stadium I wynoszą 97%, a dla stadium IV jedynie 15%. Dane z programu SEER wskazują na 5-letnie przeżycie na poziomie 95% dla raka zlokalizowanego, 69% dla raka regionalnego oraz 44% dla raka z przerzutami odległymi. Specyficzne podtypy, takie jak rak śluzowo-naskórkowy (P-MEC) wykazują 5-letnie przeżycie całkowite na poziomie 84,1%, natomiast rak w gruczolaku wielopostaciowym (CXPA) charakteryzuje się 5-letnim przeżyciem całkowitym około 50,3%. Mięsaki ślinianki przyusznej mają 5-letnie przeżycie całkowite na poziomie 52%, a rak gruczołowo-torbielowaty cechuje się najgorszym rokowaniem ze względu na naciekanie okołonerwowe i tendencję do nawrotów.

Guzy ślinianki przyusznej

Rokowanie ogólne
Rokowanie w specyficznych typach histologicznych
Kluczowe czynniki prognostyczne
Nowoczesne metody prognostyczne
Długoterminowa prognoza
Wpływ leczenia na rokowanie
Prognostyczne modele predykcyjne
Kolejne rozdziały

Rokowanie ogólne

Rokowanie w przypadku guzów ślinianki przyusznej zależy od wielu czynników, w tym histologii, stopnia zaawansowania klinicznego oraz zastosowanego leczenia. Całkowity wskaźnik 5-letniego przeżycia dla wszystkich typów histologicznych i stadiów zaawansowania wynosi około 62%. Natomiast w przypadku choroby nawrotowej 5-letnie przeżycie spada do około 37%.¹ Z uwagi na ryzyko nawrotu, wszyscy pacjenci z histologicznie potwierdzonym złośliwym guzem ślinianki przyusznej powinni być objęci dożywotnią obserwacją.

Badania dotyczące rokowania w guzach ślinianki przyusznej wykazują zróżnicowane wskaźniki przeżycia w zależności od stadium zaawansowania choroby. W badaniu przeprowadzonym przez Kim i wsp. na grupie 126 pacjentów leczonych z powodu pierwotnego raka przyusznicy, odnotowano następujące wskaźniki przeżycia specyficznego dla choroby w zależności od stadium zaawansowania: Stadium I (97%), Stadium II (81%), Stadium III (56%), Stadium IV (15%).²

Według danych z programu SEER (Surveillance, Epidemiology, and End Results) Narodowego Instytutu Raka (NCI), rokowanie jest ściśle związane z rozprzestrzenieniem nowotworu:³

Rak zlokalizowany (bez przerzutów) – 95% prawdopodobieństwo 5-letniego przeżycia
Rak regionalny (zajęcie okolicznych tkanek) – 69% prawdopodobieństwo 5-letniego przeżycia
Rak z przerzutami odległymi – 44% prawdopodobieństwo 5-letniego przeżycia

Rokowanie w specyficznych typach histologicznych

Rak śluzowo-naskórkowy ślinianki przyusznej (P-MEC) stanowi znaczący podtyp histopatologiczny nowotworów ślinianki z wewnętrzną heterogennością i złożonością. Badania dotyczące P-MEC wykazały wskaźniki przeżycia całkowitego (OS) wynoszące 0,887 dla 3 lat, 0,841 dla 5 lat i 0,753 dla 10 lat.⁴ Stopień zaawansowania guza i jego stopień zróżnicowania histologicznego są kluczowymi czynnikami prognostycznymi, często kierującymi decyzjami terapeutycznymi.

Rak w gruczolaku wielopostaciowym (Carcinoma ex pleomorphic adenoma, CXPA) jest rzadkim, ale wysoce agresywnym nowotworem złośliwym. Dla CXPA w dużych gruczołach ślinowych przeżycie całkowite wynosi 62,7% po 3 latach i 50,3% po 5 latach. Przeżycie specyficzne dla nowotworu wynosi 64,4% po 3 latach i 53,5% po 5 latach.⁵

Pierwotny rak płaskonabłonkowy ślinianki przyusznej (pPSCC) jest rzadkim nowotworem z niekorzystnym rokowaniem – wcześniej raportowane wskaźniki 5-letniego przeżycia były niższe niż 50%.⁶

Mięsaki ślinianki przyusznej, rzadkie nowotwory pochodzenia mezenchymalnego, charakteryzują się globalnym wskaźnikiem przeżycia całkowitego (OS) wynoszącym 52% po 5 latach i 34,1% po 10 latach. Wskaźniki przeżycia 5-letniego dla poszczególnych stadiów zaawansowania (T1, T2, T3, T4) wynoszą odpowiednio 80,0%, 66,5%, 56,7% i 33,3%.⁷

Spośród wszystkich typów nowotworów ślinianki przyusznej, rak gruczołowo-torbielowaty ma najmniej korzystne rokowanie ze względu na tendencję do wzrostu wzdłuż nerwów twarzy (naciekanie okołonerwowe) oraz nawrotów nawet wiele lat po pierwszym leczeniu.⁸

Kluczowe czynniki prognostyczne

Główne czynniki determinujące przeżycie w nowotworach ślinianki przyusznej to histologia i stadium kliniczne. Do niekorzystnych czynników prognostycznych należą:⁹

Wysoki stopień złośliwości
Zajęcie nerwów
Miejscowo zaawansowana choroba
Zaawansowany wiek
Towarzyszący ból
Przerzuty do regionalnych węzłów chłonnych
Przerzuty odległe
Akumulacja onkoprotein p53 lub c-erbB2

Badanie retrospektywne przeprowadzone przez Szewczyka i wsp. na 115 pacjentach z pierwotnym rakiem gruczołu ślinowego wykazało w analizie wieloczynnikowej, że wysoki stopień złośliwości guza i dodatnie marginesy chirurgiczne są niezależnymi czynnikami ryzyka nawrotu.¹⁰ Obecność przerzutów odległych wiąże się z niekorzystnym rokowaniem, z medianą przeżycia wynoszącą 4,3-7,3 miesiąca.

W nowotworach ślinianki przyusznej, stadium zaawansowania, szczególnie kategoria guza (T), jest najważniejszym czynnikiem prognostycznym. Duże guzy oraz te, które naciekają tkanki otaczające ślinianki mają mniej korzystne rokowanie.¹¹ Guzy o wysokim stopniu złośliwości mają gorsze rokowanie niż guzy o niskim stopniu, ponieważ wykazują tendencję do szybkiego wzrostu i rozprzestrzeniania się, zwiększając ryzyko nawrotu w innych częściach ciała, takich jak płuca czy kości.

W przypadku raka śluzowo-naskórkowego ślinianki przyusznej (P-MEC), wiek pacjenta, stopień złośliwości, stadium T, stadium N, radioterapia, chemioterapia i stan cywilny zostały zidentyfikowane jako niezależne czynniki prognostyczne dla przeżycia całkowitego.¹² Badania wykazały, że rokowanie u pacjentów z P-MEC jest zależne od stopnia złośliwości, z gorszym rokowaniem obserwowanym u pacjentów z wysokim stopniem złośliwości.

W przypadku raków ślinianki przyusznej naciekających podstawę czaszki, analiza systematyczna wykazała statystycznie istotną korelację między pacjentami zmarłymi z powodu guza a pacjentami zmarłymi z innych przyczyn (p=0,0001), sugerując, że inwazja podstawy czaszki negatywnie wpływa na przeżycie i powinna być uważana za niezależny czynnik prognostyczny.¹³¹⁴

Nowoczesne metody prognostyczne

Współczesne badania koncentrują się na opracowaniu zaawansowanych modeli prognostycznych wykorzystujących uczenie maszynowe, które przewyższają tradycyjne modele w przewidywaniu przeżycia. W przypadku raka śluzowo-naskórkowego ślinianki przyusznej (P-MEC), opracowany nomogram oparty na uczeniu maszynowym wykazał indeks zgodności (C-index) wynoszący 0,8499 (3 lata), 0,8557 (5 lat) i 0,8375 (10 lat) oraz wartości AUC odpowiednio 0,8670, 0,8879 i 0,8767.¹⁵ Model ten oferuje lepszą wizualizację znaczenia zmiennych w porównaniu do tradycyjnych modeli.

Badania nad pierwotnym rakiem płaskonabłonkowym ślinianki przyusznej (pPSCC) zidentyfikowały pięć niezależnych zmiennych prognostycznych dla przeżycia całkowitego (OS), w tym wiek w momencie diagnozy, przerzuty odległe, stadium AJCC, rodzaj operacji i wielkość guza. Dla przeżycia specyficznego dla nowotworu (CSS) zidentyfikowano sześć niezależnych zmiennych prognostycznych, z dodatkową zmienną w postaci zajęcia regionalnych węzłów chłonnych.¹⁶ Opracowany nomogram wykazał wyższą kliniczną korzyść netto w porównaniu do 7. wersji klasyfikacji AJCC.

Badania nad rolą przerzutów do węzłów chłonnych śródprzyuszniczych (PAR) i szyjnych w rokowaniu raka ślinianki przyusznej wykazały, że przy połączeniu klasyfikacji T z logarytmicznym ilorazem szans dodatnich węzłów chłonnych z uwzględnieniem węzłów śródprzyuszniczych (LODDS-PAR), zarówno wyższa klasyfikacja T (HR = 2,256; CI = 1,288–3,950; p = 0,004), jak i alternatywna klasyfikacja stanu węzłów chłonnych śródprzyuszniczych i szyjnych (≥mediana −1,11; HR 2,078; CI = 1,155–3,739; p = 0,015) stają się niezależnymi predyktorami gorszego przeżycia całkowitego.¹⁷ Przerzuty do węzłów chłonnych śródprzyuszniczych (PAR+) wydają się być niezależnym czynnikiem prognostycznym gorszego przeżycia całkowitego w raku ślinianki przyusznej.¹⁸

Długoterminowa prognoza

Dane dotyczące długoterminowego rokowania w nowotworach złośliwych ślinianek wskazują, że prawdopodobieństwo przeżycia specyficznego dla nowotworu (CSS) wynosi 0,83, 0,73 i 0,61 odpowiednio po 5, 10 i 15 latach. Analogiczne prawdopodobieństwo przeżycia wolnego od choroby (DFS) wynosi odpowiednio 0,69, 0,59 i 0,54.¹⁹²⁰ Te dane pokazują, że w nowotworach ślinianki przyusznej śmiertelny efekt choroby nowotworowej jest często opóźniony i przedłużony.

Według badań przeprowadzonych przez Duńską Grupę Nowotworów Głowy i Szyi, wskaźnik przeżycia specyficznego dla choroby dramatycznie spada u pacjentów zdiagnozowanych z guzami T3 i T4, a wskaźniki nawrotów są znacząco podwyższone u tych pacjentów.²¹ Ponadto, badania opublikowane przez Jeannon i wsp. w 2009 roku wykazały wyraźną korelację między zaawansowanym rozmiarem guza, wysokim stopniem złośliwości histopatologicznej a złym rokowaniem (z jedynie 35% wskaźnikiem przeżycia całkowitego) u pacjentów z nowotworami złośliwymi przyusznicy.

Wpływ leczenia na rokowanie

Leczenie chirurgiczne pozostaje podstawową metodą terapeutyczną w przypadku guzów ślinianki przyusznej, a jego zakres ma istotny wpływ na rokowanie. W przypadku mięsaków ślinianki przyusznej, analiza wieloczynnikowa wykazała, że operacja (całkowita lub radykalna parotidektomia) przeprowadzona na guzie pierwotnym była jedynym parametrem istotnie wpływającym na przeżycie wolne od nowotworu (TFS) i przeżycie specyficzne dla nowotworu (TSS).²² W związku z tym, gdy jest to możliwe na podstawie stadium zaawansowania choroby i niezależnie od typu histologicznego mięsaka, całkowita lub radykalna parotidektomia powinna być przeprowadzona w każdym wieku.

W przypadku nowotworów ślinianki przyusznej z zajęciem bocznej podstawy czaszki, leczenie jest bardzo wymagające, ale resekcja chirurgiczna, gdy jest możliwa, nadal jest zalecana, aby uniknąć obciążenia związanego z chorobą.²³ Mimo że nowotwory gruczołów ślinowych są uważane za podgrupę nowotworów głowy i szyi opornych na radioterapię, radioterapia jest rozważana w leczeniu zaawansowanych nowotworów ślinianki przyusznej.²⁴

W przypadku raka w gruczolaku wielopostaciowym (CXPA) stadium T, zajęcie węzłów chłonnych, stopień histologiczny, naciekanie okołonerwowe i zakres inwazji są ważnymi czynnikami prognostycznymi. Chirurgia jest podstawową metodą leczenia CXPA, a pooperacyjna radioterapia może być stosowana u pacjentów z czynnikami złego rokowania.²⁵

Badania nad rakiem śluzowo-naskórkowym ślinianki przyusznej (P-MEC) wykazały, że postępowanie pooperacyjne jest kluczowe dla długoterminowego rokowania pacjentów. Wyniki badań próbują analizować optymalną populację, która może odnieść korzyści z pooperacyjnej radioterapii poprzez integrację cech patologicznych i demograficznych, dostarczając ograniczonych dowodów na wybór opcji leczenia.²⁶

Prognostyczne modele predykcyjne

Rozwój zaawansowanych modeli prognostycznych stanowi ważny kierunek badań w dziedzinie nowotworów ślinianki przyusznej. Model klinicznej predykcji opracowany dla pacjentów z rakiem śluzowo-naskórkowym ślinianki przyusznej (P-MEC) w oparciu o bazę danych SEER wykazuje znaczny potencjał w przewidywaniu wskaźnika przeżycia, oferując wiarygodne wyniki do podejmowania decyzji klinicznych.²⁷ Badanie to opracowało nomogram oparty na uczeniu maszynowym do przewidywania przeżycia całkowitego u pacjentów z P-MEC po operacji, uwzględniając wiek, stopień patologiczny, stadium T, stadium N, radioterapię, chemioterapię i stan cywilny jako niezależne czynniki prognostyczne.

Podobnie, dla pierwotnego raka płaskonabłonkowego ślinianki przyusznej (pPSCC) opracowany nomogram, po wewnętrznej walidacji, wykazał wysoką dokładność i wiarygodność. To narzędzie prognostyczne może pomóc pracownikom służby zdrowia w przewidywaniu rokowania pacjentów z pPSCC i opracowywaniu zindywidualizowanych planów leczenia.²⁸

Badania wskazują, że tradycyjny system TNM i stopień patologiczny nie są wystarczające do oszacowania przeżycia lub podejmowania decyzji związanych z terapią adjuwantową w nowotworach ślinianki przyusznej.²⁹ Dlatego opracowanie bardziej kompleksowych modeli prognostycznych, uwzględniających szerszy zakres czynników, jest istotne dla poprawy przewidywania wyników leczenia i podejmowania decyzji terapeutycznych.

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Materiały źródłowe

#1 Malignant Parotid Tumors: Practice Essentials, Anatomy, Diagnosis
https://emedicine.medscape.com/article/1289616-overview
Overall 5-year survival for all stages and histologic types is approximately 62%. The overall 5-year survival for recurrent disease is approximately 37%. Because of the risk of recurrence, all patients who have had a histologically proven malignant salivary gland tumor should have lifelong follow-up. […] A study by Kim et al of 126 patients treated for primary parotid cancer found the following disease-specific survival rates for the various tumor stages (mean follow-up period 29.7 months): Stage I (97%), Stage II (81%), Stage III (56%), Stage IV (15%). […] Patients in the study underwent superficial, total, or radical parotidectomy, with 57 also undergoing postoperative radiotherapy. Fifteen patients (12%) experienced disease recurrence.
#2 Malignant Parotid Tumors: Practice Essentials, Anatomy, Diagnosis
https://emedicine.medscape.com/article/1289616-overview
Overall 5-year survival for all stages and histologic types is approximately 62%. The overall 5-year survival for recurrent disease is approximately 37%. Because of the risk of recurrence, all patients who have had a histologically proven malignant salivary gland tumor should have lifelong follow-up. […] A study by Kim et al of 126 patients treated for primary parotid cancer found the following disease-specific survival rates for the various tumor stages (mean follow-up period 29.7 months): Stage I (97%), Stage II (81%), Stage III (56%), Stage IV (15%). […] Patients in the study underwent superficial, total, or radical parotidectomy, with 57 also undergoing postoperative radiotherapy. Fifteen patients (12%) experienced disease recurrence.
#3 Salivary gland cancer: Symptoms, pictures, outlook, and causes
https://www.medicalnewstoday.com/articles/216164
The prognosis for people with salivary gland cancer depends on how far the cancer has spread from its original site. […] A person’s outlook will depend on which SEER stage a doctor diagnoses the cancer. SEER is the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results program. […] Localized cancer: If a doctor identifies and treats salivary gland cancer before it spreads from its original site, an individual is 95% as likely to survive for 5 years after diagnosis. […] Regional cancer: If this cancer spreads into nearby tissue, the rate reduces to 69%. […] Distant cancer: If the cancer spreads to distant sites, the 5-year survival rate is 44%. […] However, these vary depending on age, overall health, and the success of treatment. Only a doctor will be able to predict an accurate outlook. […] Early diagnosis and treatment are the best ways to improve a person’s outlook for salivary gland cancer.
#4 Machine learning-based survival prediction nomogram for postoperative parotid mucoepidermoid carcinoma | Scientific Reports
https://www.nature.com/articles/s41598-024-58329-8
Parotid mucoepidermoid carcinoma (P-MEC) is a significant histopathological subtype of salivary gland cancer with inherent heterogeneity and complexity. […] The study found 3-, 5-, and 10-year OS rates of 0.887, 0.841, and 0.753, respectively. […] A subsequent nomogram revealed a C-index of 0.8499 (3-year), 0.8557 (5-year), and 0.8375 (10-year) and AUC values of 0.8670, 0.8879, and 0.8767, respectively. […] Our prognostic model, grounded in machine learning, surpasses traditional models in prediction and offer superior visualization of variable importance. […] The tumors pathological grade is an important factor in determining the prognosis for MEC patients, and it often guides treatment approaches. […] However, the TNM system and pathological grade fall short in estimating survival or informing adjuvant therapy-related decisions.
#5 Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland | World Journal of Surgical Oncology | Full Text
https://wjso.biomedcentral.com/articles/10.1186/1477-7819-11-180
Carcinoma ex pleomorphic adenoma (CXPA) is an uncommon malignant tumor with highly aggressive biological behavior. Our goal was to investigate the prognosis of CXPA in the major salivary glands and factors influencing it. […] Overall survival was 62.7% at 3 years and 50.3% at 5 years. Tumor-specific survival was 64.4% at 3 years and 53.5% at 5 years. […] T stage, lymph node involvement, histological grade, perineural invasion and extent of invasion are important prognostic factors of CXPA in the major salivary glands. Surgery is the primary treatment modality for CXPA and postoperative radiation therapy may be used in patients with factors for poor prognosis.
#6 A nomogram to predict postoperative overall and cancer specific survival in patients with primary parotid squamous cell carcinoma: a population based study | Scientific Reports
https://www.nature.com/articles/s41598-025-90480-8
Primary parotid squamous cell carcinoma (pPSCC) is a rare salivary gland neoplasm. […] The prognosis for PSCC is poor, as previously reported 5-year survival rates have been less than 50%. […] Five independent prognostic variables were identified for OS, including age at diagnose, distant metastasis, AJCC stage, type of surgery, and tumor size. However, six independent prognostic variables were identified for CSS, with the addition of regional lymph node positivity as an additional variable. […] Our nomogram demonstrated a superior clinical net benefit compared to the AJCC 7th version, as indicated by DCA and ROC analysis. […] The Kaplan-Meier curve demonstrated significant differences in survival among the three groups. […] This study found that age at diagnosis, distant metastasis, AJCC stage, type of surgery, and tumor size were independent predictors of OS in patients with pPSCC. Additionally, age at diagnose, distant metastasis, AJCC stage, type of surgery, regional nodes positive, and tumor size were identified as independent predictors of CSS in pPSCC patients. […] Following internal validation, the nomogram demonstrated high accuracy and reliability. This predictive tool can assist healthcare providers in anticipating the prognosis of patients with pPSCC and devising individualized treatment plans accordingly.
#7 Systematic Review of Parotid Gland Sarcomas: Multi-Variate Analysis of Clinicopathologic Findings, Therapeutic Approaches and Oncological Outcomes That Affect Survival Rate
https://www.mdpi.com/2072-6694/14/19/4862
Primary sarcomas of the parotid gland are rare malignancies of mesenchymal origin for which there is no generally well-defined treatment guideline. The aim of this study was to analyze, through the review of the literature, the factors affecting the prognosis of patients with primary sarcoma of the parotid gland. Size/extension at the diagnosis and the sarcomaâs histotype were the most important prognostic factors. Multivariate analysis showed that surgery performed on the tumor was the only parameter affecting long-term survival. In particular, total parotidectomy with preservation or, in the most advanced cases, with the sacrifice of facial nerve should be performed at any age independently of tumor histology. […] The global overall survival (OS) is 52% at 5 years and 34.1% at 10 years. The OS for T1, T2, T3, T4 tumor at 5 years of follow up is 80.0%, 66.5%, 56.7% and 33.3%, respectively. Size/extension at the diagnosis and the sarcomaâs histotype are the most important prognostic factors. Multivariate analysis showed that surgery (total or radical parotidectomy) performed on the tumor (p = 0.0008) was the only parameter that significantly affected the OS.
#8 Prognosis and survival for salivary gland cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/salivary-gland/prognosis-and-survival
If you have salivary gland cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] The stage, especially the tumour (T) category, is the most important prognostic factor for salivary gland cancer. Large tumours and tumours that have grown into tissue around the salivary glands have a less favourable prognosis. […] High-grade tumours have a less favourable prognosis than low-grade tumours. This is because high-grade tumours are usually aggressive, which means they tend to grow and spread quickly. They also have a higher risk of coming back (recurring) in other parts of the body such as the lungs or bone. […] Adenoid cystic carcinoma has the least favourable prognosis of all types of salivary gland cancer. This is because it tends to grow into and along the nerves of the face (perineural invasion). It also tends to come back even many years after first treatment.
#9 Malignant Parotid Tumors: Practice Essentials, Anatomy, Diagnosis
https://emedicine.medscape.com/article/1289616-overview
The major determinants of survival are histology and clinical stage. Poor prognostic factors include high grade, neural involvement, locally advanced disease, advanced age, associated pain, regional lymph node metastases, distant metastasis, and accumulation of p53 or c-erbB2 oncoproteins. […] In a retrospective study by Szewczyk et al of 115 patients with primary salivary gland cancer, multivariate analysis indicated that high tumor grade and positive surgical margins are independent risk factors for tumor recurrence. […] Although statements regarding survival are difficult to make because of the large variety of histologic types, 20% of all patients will develop distant metastases. […] The presence of distant metastases heralds a poor prognosis, with a median survival of 4.3-7.3 months.
#10 Malignant Parotid Tumors: Practice Essentials, Anatomy, Diagnosis
https://emedicine.medscape.com/article/1289616-overview
The major determinants of survival are histology and clinical stage. Poor prognostic factors include high grade, neural involvement, locally advanced disease, advanced age, associated pain, regional lymph node metastases, distant metastasis, and accumulation of p53 or c-erbB2 oncoproteins. […] In a retrospective study by Szewczyk et al of 115 patients with primary salivary gland cancer, multivariate analysis indicated that high tumor grade and positive surgical margins are independent risk factors for tumor recurrence. […] Although statements regarding survival are difficult to make because of the large variety of histologic types, 20% of all patients will develop distant metastases. […] The presence of distant metastases heralds a poor prognosis, with a median survival of 4.3-7.3 months.
#11 Prognosis and survival for salivary gland cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/salivary-gland/prognosis-and-survival
If you have salivary gland cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] The stage, especially the tumour (T) category, is the most important prognostic factor for salivary gland cancer. Large tumours and tumours that have grown into tissue around the salivary glands have a less favourable prognosis. […] High-grade tumours have a less favourable prognosis than low-grade tumours. This is because high-grade tumours are usually aggressive, which means they tend to grow and spread quickly. They also have a higher risk of coming back (recurring) in other parts of the body such as the lungs or bone. […] Adenoid cystic carcinoma has the least favourable prognosis of all types of salivary gland cancer. This is because it tends to grow into and along the nerves of the face (perineural invasion). It also tends to come back even many years after first treatment.
#12 Machine learning-based survival prediction nomogram for postoperative parotid mucoepidermoid carcinoma | Scientific Reports
https://www.nature.com/articles/s41598-024-58329-8
Previous research has shown that high-grade tumors and those with positive margins are at a higher risk of recurrence and spread. […] Therefore, postoperative management is crucial for the long-term prognosis of parotid mucoepidermoid carcinoma (P-MEC) patients. […] Our study identified seven independent prognostic factors and designed KaplanMeier plots for risk stratification, potentially providing valuable insights for clinical practice. […] Age, grade, T stage, N stage, radiotherapy, chemotherapy, and marital status have been determined as independent prognostic factors for the OS of patients with P-MEC. […] Our study found that the prognosis of P-MEC patients is grade-dependent, with poor prognoses observed for patients with high grade, consistent with prior research. […] Our results attempt to analyze the optimal population that can benefit from postoperative radiotherapy by integrating pathologic and demographic characteristics, providing limited evidence for the choice of treatment options.
#13 Systematic Review of Management and Survival Outcome of Parotid Cancers with Lateral Skull Base Invasion
https://pmc.ncbi.nlm.nih.gov/articles/PMC10447298/
Lateral skull base involvement from parotid cancers is a rare condition and is considered a poor prognostic indicator. […] At the last follow-up, more patients died of disease (DOD; 60/289, 21%) than other causes (DOOC; 5/289, 2%). […] There is a statistically significant correlation between patients died for tumor (DOD) and patients died for other causes (DOOC) (p=0.0001), suggesting that the lateral skull base invasion negatively impacts on survival. […] Basing on the results of our systematic review, lateral skull base involvement from parotid recurrent/advance tumors should be considered a poor prognostic factor, as the majority of patients die due to this condition. […] The treatment of parotid gland cancers with lateral skull base involvement is very challenging, and when it is possible, the surgical resection is still recommended to avoid the burden of the disease;
#14 Systematic Review of Management and Survival Outcome of Parotid Cancers with Lateral Skull Base Invasion
https://pmc.ncbi.nlm.nih.gov/articles/PMC10447298/
Despite salivary gland tumors are considered a radio resistant subset of head and neck tumors, radiotherapy has been considered in the treatment of advanced parotid cancers; […] Our analysis showed a statistically significant correlation between patients died for tumor (DOD) and patients died for other causes (DOOC) (p=0.0001), suggesting that the lateral skull base invasion negatively impacts on survival, and should be considered as an independent prognostic factor. […] Basing on the results of our systematic review, it should be considered a poor prognostic factor, as the majority of patients die due to this condition.
#15 Machine learning-based survival prediction nomogram for postoperative parotid mucoepidermoid carcinoma | Scientific Reports
https://www.nature.com/articles/s41598-024-58329-8
Parotid mucoepidermoid carcinoma (P-MEC) is a significant histopathological subtype of salivary gland cancer with inherent heterogeneity and complexity. […] The study found 3-, 5-, and 10-year OS rates of 0.887, 0.841, and 0.753, respectively. […] A subsequent nomogram revealed a C-index of 0.8499 (3-year), 0.8557 (5-year), and 0.8375 (10-year) and AUC values of 0.8670, 0.8879, and 0.8767, respectively. […] Our prognostic model, grounded in machine learning, surpasses traditional models in prediction and offer superior visualization of variable importance. […] The tumors pathological grade is an important factor in determining the prognosis for MEC patients, and it often guides treatment approaches. […] However, the TNM system and pathological grade fall short in estimating survival or informing adjuvant therapy-related decisions.
#16 A nomogram to predict postoperative overall and cancer specific survival in patients with primary parotid squamous cell carcinoma: a population based study | Scientific Reports
https://www.nature.com/articles/s41598-025-90480-8
Primary parotid squamous cell carcinoma (pPSCC) is a rare salivary gland neoplasm. […] The prognosis for PSCC is poor, as previously reported 5-year survival rates have been less than 50%. […] Five independent prognostic variables were identified for OS, including age at diagnose, distant metastasis, AJCC stage, type of surgery, and tumor size. However, six independent prognostic variables were identified for CSS, with the addition of regional lymph node positivity as an additional variable. […] Our nomogram demonstrated a superior clinical net benefit compared to the AJCC 7th version, as indicated by DCA and ROC analysis. […] The Kaplan-Meier curve demonstrated significant differences in survival among the three groups. […] This study found that age at diagnosis, distant metastasis, AJCC stage, type of surgery, and tumor size were independent predictors of OS in patients with pPSCC. Additionally, age at diagnose, distant metastasis, AJCC stage, type of surgery, regional nodes positive, and tumor size were identified as independent predictors of CSS in pPSCC patients. […] Following internal validation, the nomogram demonstrated high accuracy and reliability. This predictive tool can assist healthcare providers in anticipating the prognosis of patients with pPSCC and devising individualized treatment plans accordingly.
#17 Role of Intraparotid and Neck Lymph Node Metastasis in Primary Parotid Cancer Surgery: A Population-Based Analysis
https://www.mdpi.com/2072-6694/14/12/2822
The significant factors were grouped for the multivariate analyses. […] When combining T with LODDS instead of N classification, higher T classification (T3/T4) become a negative prognosticator (HR = 2.588; CI = 1.329â5.040; p = 0.005) but not LODDS (p > 0.05). […] Finally, when combining the T classification with LODDS-PAR, both higher T classification (HR = 2.256; CI = 1.288â3.950; p = 0.004) and the alternative classification of the intraparotid and cervical lymph node status (â¥median â1.11; HR 2.078; CI = 1.155â3.739; p = 0.015) become independent predictors of worse OS. […] A large population-based study on patients with primary parotid carcinoma confirmed that intraparotid lymph node metastasis is an indicator for worse overall survival. Furthermore, the inclusion of the intraparotid lymph node status into the alternative lymph node assessment with the log odds of positive lymph node (LODDS) formula led to a robust prognosticator of the lymph node status in the multivariate analysis. In contrast, and confirming data of several other studies, standard N classification was less accurate in multivariate analysis.
#18 Role of Intraparotid and Neck Lymph Node Metastasis in Primary Parotid Cancer Surgery: A Population-Based Analysis
https://www.mdpi.com/2072-6694/14/12/2822
The prognostic role of intraparotid (PAR) and cervical lymph node (LN) metastasis on overall survival (OS) of primary parotid cancer is unclear. […] OS was assessed in relation to the total number of removed PAR and cervical LN, number of positive intraparotid (PAR+), positive cervical LN, LN ratio, log odds of positive LN (LODDS), as well as including the PAR as LODDS-PAR. […] T and N classification were not independent predictors of OS. When combining T with LODDS instead of N, higher T became a strong prognosticator, but not LODDS. […] When combining T classification with LODDS-PAR, both higher T classification and the classification with LODDS-PAR became independent predictors of worse OS. LODDS-PAR seems to be an optimal prognosticator for OS in primary parotid cancer. […] Intraparotid metastasis (PAR+) seems to be an independent prognosticator for worse overall survival in parotid cancer.
#19 Survival Probabilities Related to Histology, Grade and Stage in Patients With Salivary Gland Tumors | Anticancer Research
https://ar.iiarjournals.org/content/39/2/641
The probability of CSS was 0.83, 0.73 and 0.61 at 5, 10 and 15 years, respectively; corresponding probability of DFS was 0.69, 0.59 and 0.54, respectively. […] Tumor histology, grade and stage are well established factors in predicting prognosis. […] A review published by Jeannon et al. in 2009 showed the clear correlation among advanced tumor size, high-grade histopathology and poor prognosis (with only 35% overall survival rate) in patients with parotid malignant tumors. […] Furthermore, tumor size was suggested by Speight et al. to be a critical predictive factor, more important than histopathological grade. […] According to the results published in 2011 by the Danish Head and Neck Cancer Group, disease-specific survival rate decreases dramatically for patients diagnosed with T3 and T4 tumors, and recurrence rates are significantly increased in these patients.
#20 Survival Probabilities Related to Histology, Grade and Stage in Patients With Salivary Gland Tumors | Anticancer Research
https://ar.iiarjournals.org/content/39/2/641
In summary, one can conclude from the currently presented data that the CSS and the DFS probabilities in salivary malignancies were quite high at 5 years (0.69-0.83), higher than, for example, in oral cancer. However, these rates dropped over the long-term and at 15 years they reached 0.54-0.61; this shows that in salivary gland cancer, the lethal effect of malignancy is often delayed and prolonged. Tumor histology, grade and stage certainly play a role in predicting prognosis; however, other factors such as molecular markers should be further studied for their role in an effort to improve prognosis prediction.
#21 Survival Probabilities Related to Histology, Grade and Stage in Patients With Salivary Gland Tumors | Anticancer Research
https://ar.iiarjournals.org/content/39/2/641
The probability of CSS was 0.83, 0.73 and 0.61 at 5, 10 and 15 years, respectively; corresponding probability of DFS was 0.69, 0.59 and 0.54, respectively. […] Tumor histology, grade and stage are well established factors in predicting prognosis. […] A review published by Jeannon et al. in 2009 showed the clear correlation among advanced tumor size, high-grade histopathology and poor prognosis (with only 35% overall survival rate) in patients with parotid malignant tumors. […] Furthermore, tumor size was suggested by Speight et al. to be a critical predictive factor, more important than histopathological grade. […] According to the results published in 2011 by the Danish Head and Neck Cancer Group, disease-specific survival rate decreases dramatically for patients diagnosed with T3 and T4 tumors, and recurrence rates are significantly increased in these patients.
#22 Systematic Review of Parotid Gland Sarcomas: Multi-Variate Analysis of Clinicopathologic Findings, Therapeutic Approaches and Oncological Outcomes That Affect Survival Rate
https://www.mdpi.com/2072-6694/14/19/4862
The size/extension of the tumor (T according to AJCC) was the most important prognostic factor. The OS for T1 stage tumor at 5 years of follow-up was 80.0%, while those for T2, T3 and T4 at 5 years were 66.5%, 56.7% and 33.3%, respectively. The histologic type of the sarcoma was another important prognostic factor. […] The multi-linear regression analysis showed that surgery (total or radical parotidectomy) performed on the primary tumor was the only parameter that significantly affected TFS and TSS. Consequently, when feasible based on the stage of the disease and regardless of the sarcomaâs histotype, total or radical parotidectomy should be performed at any age.
#23 Systematic Review of Management and Survival Outcome of Parotid Cancers with Lateral Skull Base Invasion
https://pmc.ncbi.nlm.nih.gov/articles/PMC10447298/
Lateral skull base involvement from parotid cancers is a rare condition and is considered a poor prognostic indicator. […] At the last follow-up, more patients died of disease (DOD; 60/289, 21%) than other causes (DOOC; 5/289, 2%). […] There is a statistically significant correlation between patients died for tumor (DOD) and patients died for other causes (DOOC) (p=0.0001), suggesting that the lateral skull base invasion negatively impacts on survival. […] Basing on the results of our systematic review, lateral skull base involvement from parotid recurrent/advance tumors should be considered a poor prognostic factor, as the majority of patients die due to this condition. […] The treatment of parotid gland cancers with lateral skull base involvement is very challenging, and when it is possible, the surgical resection is still recommended to avoid the burden of the disease;
#24 Systematic Review of Management and Survival Outcome of Parotid Cancers with Lateral Skull Base Invasion
https://pmc.ncbi.nlm.nih.gov/articles/PMC10447298/
Despite salivary gland tumors are considered a radio resistant subset of head and neck tumors, radiotherapy has been considered in the treatment of advanced parotid cancers; […] Our analysis showed a statistically significant correlation between patients died for tumor (DOD) and patients died for other causes (DOOC) (p=0.0001), suggesting that the lateral skull base invasion negatively impacts on survival, and should be considered as an independent prognostic factor. […] Basing on the results of our systematic review, it should be considered a poor prognostic factor, as the majority of patients die due to this condition.
#25 Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland | World Journal of Surgical Oncology | Full Text
https://wjso.biomedcentral.com/articles/10.1186/1477-7819-11-180
Carcinoma ex pleomorphic adenoma (CXPA) is an uncommon malignant tumor with highly aggressive biological behavior. Our goal was to investigate the prognosis of CXPA in the major salivary glands and factors influencing it. […] Overall survival was 62.7% at 3 years and 50.3% at 5 years. Tumor-specific survival was 64.4% at 3 years and 53.5% at 5 years. […] T stage, lymph node involvement, histological grade, perineural invasion and extent of invasion are important prognostic factors of CXPA in the major salivary glands. Surgery is the primary treatment modality for CXPA and postoperative radiation therapy may be used in patients with factors for poor prognosis.
#26 Machine learning-based survival prediction nomogram for postoperative parotid mucoepidermoid carcinoma | Scientific Reports
https://www.nature.com/articles/s41598-024-58329-8
Previous research has shown that high-grade tumors and those with positive margins are at a higher risk of recurrence and spread. […] Therefore, postoperative management is crucial for the long-term prognosis of parotid mucoepidermoid carcinoma (P-MEC) patients. […] Our study identified seven independent prognostic factors and designed KaplanMeier plots for risk stratification, potentially providing valuable insights for clinical practice. […] Age, grade, T stage, N stage, radiotherapy, chemotherapy, and marital status have been determined as independent prognostic factors for the OS of patients with P-MEC. […] Our study found that the prognosis of P-MEC patients is grade-dependent, with poor prognoses observed for patients with high grade, consistent with prior research. […] Our results attempt to analyze the optimal population that can benefit from postoperative radiotherapy by integrating pathologic and demographic characteristics, providing limited evidence for the choice of treatment options.
#27 Machine learning-based survival prediction nomogram for postoperative parotid mucoepidermoid carcinoma | Scientific Reports
https://www.nature.com/articles/s41598-024-58329-8
Despite these limitations, our clinical prediction model shows substantial potential in predicting the survival rate of P-MEC patients based on SEER database, offering reliable results for clinical decision-making. […] In conclusion, this study developed a machine learning-based nomogram for predicting overall survival in postoperative P-MEC patients, incorporating age, pathological grade, T stage, N stage, radiation therapy, chemotherapy, and marital status as independent prognostic factors.
#28 A nomogram to predict postoperative overall and cancer specific survival in patients with primary parotid squamous cell carcinoma: a population based study | Scientific Reports
https://www.nature.com/articles/s41598-025-90480-8
Primary parotid squamous cell carcinoma (pPSCC) is a rare salivary gland neoplasm. […] The prognosis for PSCC is poor, as previously reported 5-year survival rates have been less than 50%. […] Five independent prognostic variables were identified for OS, including age at diagnose, distant metastasis, AJCC stage, type of surgery, and tumor size. However, six independent prognostic variables were identified for CSS, with the addition of regional lymph node positivity as an additional variable. […] Our nomogram demonstrated a superior clinical net benefit compared to the AJCC 7th version, as indicated by DCA and ROC analysis. […] The Kaplan-Meier curve demonstrated significant differences in survival among the three groups. […] This study found that age at diagnosis, distant metastasis, AJCC stage, type of surgery, and tumor size were independent predictors of OS in patients with pPSCC. Additionally, age at diagnose, distant metastasis, AJCC stage, type of surgery, regional nodes positive, and tumor size were identified as independent predictors of CSS in pPSCC patients. […] Following internal validation, the nomogram demonstrated high accuracy and reliability. This predictive tool can assist healthcare providers in anticipating the prognosis of patients with pPSCC and devising individualized treatment plans accordingly.
#29 Machine learning-based survival prediction nomogram for postoperative parotid mucoepidermoid carcinoma | Scientific Reports
https://www.nature.com/articles/s41598-024-58329-8
Parotid mucoepidermoid carcinoma (P-MEC) is a significant histopathological subtype of salivary gland cancer with inherent heterogeneity and complexity. […] The study found 3-, 5-, and 10-year OS rates of 0.887, 0.841, and 0.753, respectively. […] A subsequent nomogram revealed a C-index of 0.8499 (3-year), 0.8557 (5-year), and 0.8375 (10-year) and AUC values of 0.8670, 0.8879, and 0.8767, respectively. […] Our prognostic model, grounded in machine learning, surpasses traditional models in prediction and offer superior visualization of variable importance. […] The tumors pathological grade is an important factor in determining the prognosis for MEC patients, and it often guides treatment approaches. […] However, the TNM system and pathological grade fall short in estimating survival or informing adjuvant therapy-related decisions.