Survival benefit of cancer-directed surgery and the role of adjuvant therapy in malignant major salivary gland cancers: a propensity score matched retrospective analysis.

IF 1.7 Q3 DENTISTRY, ORAL SURGERY & MEDICINE Oral and Maxillofacial Surgery-Heidelberg Pub Date : 2025-01-09 DOI:10.1007/s10006-024-01316-0

Ahmed Elkoumi, Omar Elkoumi, Mohamed Hamouda Elkasaby, Huzifa Khitiy, Mariam Khaled Elbairy, Ahmed Tawfik, Omar K Habib, Abeer Shaalan

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Abstract

Background: The primary objective of this study was to assess the benefit of cancer-directed surgery (CDS) on both overall survival (OS) and cancer-specific survival (CSS) of patients with malignant major salivary gland cancers (MMSGCs). The secondary objective was to explore the benefits of adjuvant therapy on the survival outcomes of these patients.

Methods: Patients diagnosed with MMSGC were extracted from the SEER database and subsequently categorized into two cohorts: CDS and non-CDS. Propensity score matching (PSM) was used to mitigate confounding variables. The survival benefit associated with CDS was evaluated using Kaplan-Meier analysis, log-rank tests, and Cox proportional hazard models. Furthermore, the impact of adjuvant radiotherapy and chemotherapy was explored within the CDS subgroup.

Results: A total of 7,029 patients with MMSGC were included. PSM was performed and resulted in a matched cohort between both groups, including 595 patients in each group. Multivariable Cox proportional hazard indicated that patients who received CDS had better OS (HR: 0.45, 95% CI [0.39 to 0.52], P < 0.001) and CSS (HR: 0.46, 95% CI [0.40 to 0.52], P < 0.001). The 5- and 10-year OS for the CDS group was 42% (95% CI, 38 - 46%), and 25% (95% CI, 21 - 29%) consecutively, while the 5- and 10-year OS for the non-CDS group was 20% (95% CI, 17 - 24%), and 12% (95% CI, 9.7 - 16%) consecutively. Moreover, patients with younger age, localized tumors, and lower TNM stage could benefit more from CDS. Radiotherapy as adjuvant therapy was found to be beneficial (HR: 0.69, 95% CI [0.55-0.85], p < 0.001), while chemotherapy could not significantly benefit these patients.

Conclusion: CDS improved the OS and CSS survival in MMSGC patients. Specific patient subgroups seemed to have a superior benefit from CDS. Adjuvant radiotherapy could help enhance the survival outcomes of these patients while chemotherapy could not.

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恶性大唾液腺癌肿瘤定向手术的生存获益和辅助治疗的作用：倾向评分匹配回顾性分析

背景：本研究的主要目的是评估癌症定向手术（CDS）对恶性大涎腺癌（MMSGCs）患者总生存期（OS）和癌症特异性生存期（CSS）的益处。次要目的是探讨辅助治疗对这些患者生存结果的益处。方法：从SEER数据库中提取诊断为MMSGC的患者，随后将其分为两组：CDS和非CDS。倾向得分匹配（PSM）用于减轻混杂变量。使用Kaplan-Meier分析、log-rank检验和Cox比例风险模型评估与CDS相关的生存获益。此外，在CDS亚组中探讨了辅助放疗和化疗的影响。结果：共纳入7029例MMSGC患者。进行PSM并在两组之间形成匹配的队列，每组包括595名患者。多变量Cox比例风险提示，接受CDS的患者有更好的OS (HR: 0.45, 95% CI [0.39 ~ 0.52])， P结论：CDS改善了MMSGC患者的OS和CSS生存。特定的患者亚组似乎从CDS中获益更大。辅助放疗可以提高这些患者的生存结果，而化疗则不能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral and Maxillofacial Surgery-Heidelberg DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

3.20

自引率

5.60%

发文量

118

期刊介绍： Oral & Maxillofacial Surgery founded as Mund-, Kiefer- und Gesichtschirurgie is a peer-reviewed online journal. It is designed for clinicians as well as researchers.The quarterly journal offers comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery and interdisciplinary aspects of cranial, facial and oral diseases and their management. The journal publishes papers of the highest scientific merit and widest possible scope on work in oral and maxillofacial surgery as well as supporting specialties. Practice-oriented articles help improve the methods used in oral and maxillofacial surgery.Every aspect of oral and maxillofacial surgery is fully covered through a range of invited review articles, clinical and research articles, technical notes, abstracts, and case reports. Specific topics are: aesthetic facial surgery, clinical pathology, computer-assisted surgery, congenital and craniofacial deformities, dentoalveolar surgery, head and neck oncology, implant dentistry, oral medicine, orthognathic surgery, reconstructive surgery, skull base surgery, TMJ and trauma.Time-limited reviewing and electronic processing allow to publish articles as fast as possible. Accepted articles are rapidly accessible online.Clinical studies submitted for publication have to include a declaration that they have been approved by an ethical committee according to the World Medical Association Declaration of Helsinki 1964 (last amendment during the 52nd World Medical Association General Assembly, Edinburgh, Scotland, October 2000). Experimental animal studies have to be carried out according to the principles of laboratory animal care (NIH publication No 86-23, revised 1985).