Cervical Lymph Node Invasion in Pediatric Salivary Gland Malignancies: Clinical Overview and Therapeutic Implications

IF 2.3 3区医学 Q2 HEMATOLOGY Pediatric Blood & Cancer Pub Date : 2025-02-03 DOI:10.1002/pbc.31581

Celine Richard, Matthieu Carton, Inbal Hazkani, Vincent Couloigner, Anthony Sheyn, Jeffrey Rastatter, Linda Haroun, Sara Helmig, Mary Beth Houston, Sylvie Helfre, Eric Thebault, Nicolas Andre, Cecile Faure Conter, Natacha Teissier, Brice Fresneau, Daniel Orbach

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Abstract

Background and Aims

Pediatric salivary gland malignancies (SGM) present challenges in managing cervical nodes. We aimed to characterize lymph node invasion to inform decisions regarding the need of systematic wide lymph node dissection (WLND).

Methods

International retrospective study, conducted across seven large French and American pediatric centers, including pediatric patients (0–18 years) diagnosed with SGM from 2000 to 2020.

Results

Among the 82 patients (median age 13 years), the parotid gland was frequently affected (60 cases). Histotypes comprised mucoepidermoid (mucoepidermoid carcinoma [MEC], 43 cases), acinic cells (acinic cells carcinoma [AcCC], 22 cases), adenoid cystic (adenoid cystic carcinoma [AdCC], 8 cases), (MASC, 6 cases), and adenocarcinoma (3 cases). Primary treatments were surgery (82 cases) and radiotherapy (20 cases; median dosage 64 gray). Cervical nodes therapy included WLND (≥2 levels, 29 cases), limited nodes resection (LNR; one level, 13 cases), and/or irradiation (4 cases; median 54 gray; range 52.0–63.0). At diagnosis, six patients had cervical node invasion (CNI) managed with LNR (four cases), WLND (two cases), and radiotherapy (three cases). After a median follow-up of 6 years (range 1–22), nine patients had tumor event: local (four cases), cervical relapse/progression (three cases) or combined (two cases). Of the nine with CNI, at diagnosis or relapse, four had MASC. Five-year event-free and overall survival (OS) rates were, respectively, 90.1% and 98.8%.

Conclusions

CNI is rare in pediatric SGM but noted in 11% of cases, with higher incidence in MASC. Overall, outcome in SGM is good with a tailored locoregional multidisciplinary approach. Systematic lymph node dissection should be reconsidered.

SUMMARY

This international multi-institutional study analyzed the clinical presentation and the cervical pattern of relapse of 82 pediatric patients with newly diagnosed salivary gland malignancies. Overall, nodal invasion was rare at diagnosis and only noted in 7%. In addition, 6% developed nodal relapse during follow-up. Incidence of nodal spread was frequent in mammary analogue secretory carcinoma (MASC). The overall outcome was promising with a tailored locoregional multidisciplinary approach. Systematic lymph node dissection should be reconsidered in pediatric salivary gland tumors.

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小儿唾液腺恶性肿瘤的颈部淋巴结侵袭：临床综述和治疗意义。

背景和目的：小儿涎腺恶性肿瘤（SGM）在管理宫颈淋巴结方面提出了挑战。我们的目的是表征淋巴结侵袭，以告知是否需要系统性宽淋巴结清扫（WLND）的决定。方法：国际回顾性研究，在7个大型法国和美国儿科中心进行，包括2000年至2020年诊断为SGM的儿科患者（0-18岁）。结果：82例患者中位年龄13岁，以腮腺为主（60例）。组织类型包括粘液表皮样癌（muco表皮样癌[MEC]， 43例）、腺泡细胞癌（acic细胞癌[AcCC]， 22例）、腺样囊性癌（腺样囊性癌[AdCC]， 8例）、腺癌（MASC， 6例）和腺癌（3例）。主要治疗方法为手术（82例）加放疗（20例）；中位剂量64（灰色）。宫颈淋巴结治疗包括WLND（≥2级，29例）、有限淋巴结切除术(LNR；一个水平，13例)，和/或照射(4例；中位数54灰色；范围52.0 - -63.0)。诊断时，6例患者有宫颈结浸润（CNI），分别采用LNR（4例）、WLND（2例）和放疗（3例）。在中位随访6年（范围1-22年）后，9例患者发生肿瘤事件：局部（4例），宫颈复发/进展（3例）或合并（2例）。在确诊或复发的9名CNI患者中，4名患有MASC。5年无事件生存率和总生存率（OS）分别为90.1%和98.8%。结论：CNI在儿童SGM中很少见，但在11%的病例中被注意到，在MASC中发病率更高。总体而言，采用量身定制的局部区域多学科方法治疗SGM的结果良好。应重新考虑系统性淋巴结清扫。摘要：这项国际多机构研究分析了82例新诊断的唾液腺恶性肿瘤患儿的临床表现和宫颈复发模式。总体而言，结节浸润在诊断时很少见，仅占7%。此外，6%的患者在随访期间出现淋巴结复发。乳腺类似物分泌性癌（MASC）淋巴结转移发生率高。通过量身定制的地方区域多学科方法，总体结果是有希望的。小儿唾液腺肿瘤应重新考虑系统性淋巴结清扫。

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

Pediatric Blood & Cancer 医学-小儿科

CiteScore

4.90

自引率

9.40%

发文量

546

审稿时长

1.5 months

期刊介绍： Pediatric Blood & Cancer publishes the highest quality manuscripts describing basic and clinical investigations of blood disorders and malignant diseases of childhood including diagnosis, treatment, epidemiology, etiology, biology, and molecular and clinical genetics of these diseases as they affect children, adolescents, and young adults. Pediatric Blood & Cancer will also include studies on such treatment options as hematopoietic stem cell transplantation, immunology, and gene therapy.