Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients

Oliveira Filho, Osias Vieira de; Rêgo, Talita Jordânia Rocha do; Mendes, Felipe Herbert de Oliveira; Dantas, Thinali Sousa; Cunha, Maria do Perpétuo Socorro Saldanha; Malta, Cássia Emanuella Nóbrega; Silva, Paulo Goberlânio de Barros; Sousa, Fabrício Bitu

doi:10.1016/j.bjorl.2020.06.016

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 88 (3) • May-Jun 2022 • https://doi.org/10.1016/j.bjorl.2020.06.016 copy

Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival.

Objective

To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands

Methods

This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05).

Results

The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116 ± 6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p = 0.001), referral origin from the public health system (p = 0.011), T stage (p = 0.007), M stage (p < 0.001), clinical stage (p < 0.001), compromised surgical margins (p = 0.013), and chemotherapy (p < 0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p = 0.016). The level of education was the only factor more prevalent in older patients (p = 0.011).

Conclusion

Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.

Keywords
Survival analysis; Oral neoplasms; Parotid neoplasms; Submandibular gland neoplasms; Sublingual gland neoplasms

		Death			Average survival
	Total	Alive	Death	p-value	Average survival	p-value
Sex
Male	94 (48.7%)	55 (42.3%)	39 (61.9%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	0.011^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	102 ± 8	0.026^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
Female	99 (51.3%)	75 (57.7%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	24 (38.1%)		130 ± 7^b b p < 0.05, Log-rank Mantel-Cox test; data are expressed as the mean and standard error devised by Kaplan-Meier curves.
Age
Up to 50 years	81 (42.0%)	64 (49.2%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	17 (27.0%)	0.003^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	133 ± 7^b b p < 0.05, Log-rank Mantel-Cox test; data are expressed as the mean and standard error devised by Kaplan-Meier curves.	0.001^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
Over 50 years	112 (58.0%)	66 (50.8%)	46 (73.0%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.		102 ± 7
Race
White	75 (40.8%)	52 (43.0%)	23 (36.5%)	0.491	110 ± 7	0.442
Dark skin	109 (59.2%)	69 (57.0%)	40 (63.5%)		116 ± 8
Education level
Illiterate / Incomplete elementary school	78 (56.9%)	43 (49.4%)	35 (70.0%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	0.019^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	110 ± 7	0.212
Complete Elementary school or higher	59 (43.1%)	44 (50.6%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	15 (30.0%)		116 ± 8
Origin
Metropolitan area	97 (50.3%)	73 (56.2%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	24 (38.1%)	0.019^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	130 ± 7^b b p < 0.05, Log-rank Mantel-Cox test; data are expressed as the mean and standard error devised by Kaplan-Meier curves.	0.011^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
Rural area	96 (49.7%)	57 (43.8%)	39 (61.9%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.		102 ± 8
Marital status
Married	52 (27.1%)	39 (30.2%)	13 (20.6%)	0.358	125 ± 10	0.594
Unmarried	111 (57.8%)	72 (55.8%)	39 (61.9%)		114 ± 7
Others	29 (15.1%)	18 (14.0%)	11 (17.5%)		102 ± 12
Referral
Public Health System	96 (77.4%)	59 (73.8%)	37 (84.1%)	0.188	109 ± 10	0.278
Private Health System	28 (22.6%)	21 (26.3%)	7 (15.9%)		106 ± 7
Family history
Yes	28 (46.7%)	22 (50.0%)	6 (37.5%)	0.391	91 ± 8	0.747
No	32 (53.3%)	22 (50.0%)	10 (62.5%)		108 ± 9
Alcoholism
Yes	52 (88.1%)	38 (88.4%)	14 (87.5%)	1.000	105 ± 8	1.000
No	7 (11.9%)	5 (11.6%)	2 (12.5%)		37 ± 6
Smoking
Yes	43 (78.2%)	35 (83.3%)	8 (61.5%)	0.129	102 ± 6	0.070
No	12 (21.8%)	7 (16.7%)	5 (38.5%)		73 ± 13

		Death			Average Survival
	Total	Alive	Death	p-value	Average Survival	Total
Location
Minor	66 (34.2%)	50 (38.5%)	16 (25.4%)	0.073	130 ± 9	0.097
Major	127 (65.8%)	80 (61.5%)	47 (74.6%)		110 ± 7
Histological type
AC-NOS	61 (32.1%)	35 (26.9%)	27 (42.9%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	0.023^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	101 ± 10	0.054
ACC	60 (31.1%)	39 (30.0%)	21 (33.3%)		114 ± 9
MEC	36 (18.7%)	31 (23.8%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	5 (7.9%)		130 ± 8^b b p < 0.05, Log-rank Mantel-Cox test; data are expressed as the mean and standard error devised by Kaplan-Meier curves.
Others	36 (18.7%)	25 (19.2%)	10 (15.9%)		109 ± 11
T
1	14 (23.7%)	13 (32.5%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	1 (5.3%)	0.038^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	146 ± 9^b b p < 0.05, Log-rank Mantel-Cox test; data are expressed as the mean and standard error devised by Kaplan-Meier curves.	0.007^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
2	21 (35.6%)	13 (32.5%)	8 (42.1%)		103 ± 10
3	12 (20.3%)	9 (22.5%)	3 (15.8%)		120 ± 23
4	12 (20.3%)	5 (12.5%)	7 (36.8%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.		58 ± 15
N
N0	45 (81.8%)	32 (84.2%)	13 (76.5%)	0.479	124 ± 10	0.342
N+	9 (16.4%)	6 (15.8%)	4 (23.5%)		81 ± 16
M
0	56 (87.5%)	38 (95.0%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	18 (75.0%)	0.044^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	118 ± 9^b b p < 0.05, Log-rank Mantel-Cox test; data are expressed as the mean and standard error devised by Kaplan-Meier curves.	<0.001
1	8 (12.5%)	2 (5.0%)	6 (25.0%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.		35 ± 12
Stage
1	16 (22.9%)	15 (33.3%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	1 (4.0%)	0.002^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	156 ± 10^b b p < 0.05, Log-rank Mantel-Cox test; data are expressed as the mean and standard error devised by Kaplan-Meier curves.	<0.001
2	20 (28.6%)	13 (28.9%)	7 (28.0%)		127 ± 13
3	10 (14.3%)	8 (17.8%)	2 (8.0%)		109 ± 15
4	24 (34.3%)	9 (20.0%)	15 (60.0%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.		53 ± 10
Surgery
No	100 (51.8%)	65 (50.0%)	35 (55.6%)	0.469	111 ± 8	0.325
Yes	93 (48.2%)	65 (50.0%)	28 (44.4%)		121 ± 8
Compromised surgical margins
No	32 (34.4%)	29 (44.6%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	3 (10.7%)	0.002	145 ± 9	0.013
Yes	61 (65.6%)	36 (55.4%)	25 (89.3%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.		109 ± 9
RT
No	71 (36.8%)	50 (38.5%)	21 (33.3%)	0.488	122 ± 9	0.598
Yes	122 (63.2%)	80 (61.5%)	42 (66.7%)		113 ± 7
CT
No	168 (87.0%)	119 (91.5%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	49 (77.8%)	0.008^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	122 ± 7^b b p < 0.05, Log-rank Mantel-Cox test; data are expressed as the mean and standard error devised by Kaplan-Meier curves.	<0.001
Yes	25 (13.0%)	11 (8.5%)	14 (22.2%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.		66 ± 17

	p-value	Adjusted HR	95% CI
Sex	0.833	1.230	0.178	8.458
Age	0.016^a a p < 0.05, Cox regression forward stepwise model.	9.967	5.772	171.507
Origin	0.062	6.217	0.628	26.731
Smoking	1.000	0.470	0.008	7.421
Location	0.052	4.021	0.939	17.287
Histological type	0.053	0.193	0.036	1.024
T	0.082	5.471	0.987	20.512
M	0.087	0.397	0.016	7.779
Staging	0.080	0.021	0.001	1.838
Compromised surgical margins	0.999	1.390	0.123	13.912
CT	0.089	1.454	0.117	1.808

	Age		p-value
	Up to 50 years	Over 50 years
Sex
Male	32 (39.5%)	62 (55.4%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	0.030
Female	49 (60.5%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	50 (44.6%)
Race
White	33 (43.4%)	42 (38.9%)	0.538
Dark skin	43 (56.6%)	66 (61.1%)
Education level
Illiterate / Incomplete elementary school	20 (39.2%)	58 (67.4%)^b	0.002^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
> Elementary school	31(60.8%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	28 (32.6%)
Origin
Metropolitan area	44 (54.3%)	53 (47.3%)	0.337
Rural area	37 (45.7%)	59 (52.7%)
Marital status
Married	35 (43.2%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	17 (15.3%)	<0.001
Singles	41 (50.6%)	70 (63.1%)
Divorced / Separate	5 (6.2%)	24 (21.6%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
Referral
Public Health System	43 (79.6%)	53 (75.7%)	0.605
Private Health System	11 (20.4%)	17 (24.3%)
Family history
Yes	9 (47.4%)	19 (46.3%)	0.941
No	10 (52.6%)	22 (53.7%)
Alcoholism
Yes	22 (95.7%)	30 (83.3%)	0.229
No	1 (4.3%)	6 (16.7%)
Smoking
Yes	21 (100.0%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	22 (64.7%)	0.002^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
No	0 (0.0%)	12 (35.3%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
Location
Minor	28 (34.6%)	38 (33.9%)	1.000
Major	53 (65.4%)	74 (66.1%)
Histological type
NOS-AC	19 (23.5%)	43 (38.4%)	0.086
ACC	28 (34.6%)	32 (28.6%)
MEC	20 (24.7%)	16 (14.3%)
Others	14 (17.3%)	21 (18.8%)
T
1	10 (35.7%)	4 (12.9%)	0.210
2	9 (32.1%)	12 (38.7%)
3	4 (14.3%)	8 (25.8%)
4	5 (17.9%)	7 (22.6%)
N
N0	24 (85.7%)	21 (77.8%)	0.503
N+	4 (14.3%)	6 (22.2%)
M
0	26 (86.7%)	30 (88.2%)	1.000
1	4 (13.3%)	4 (11.8%)
Staging
1	11 (33.3%)	5 (13.5%)	0.164
2	10 (30.3%)	10 (27.0%)
3	4 (12.1%)	6 (16.2%)
4	8 (24.2%)	16 (43.2%)
Surgery
No	41 (50.6%)	59 (52.7%)	0.884
Yes	40 (49.4%)	53 (47.3%)
Compromised surgical margins
No	23 (57.5%)	38 (71.7%)	0.201
Yes	17 (42.5%)	15 (28.3%)
RT
No	37 (45.7%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	34 (30.4%)	0.029^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
Yes	44 (54.3%)	78 (69.6%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
CT
No	76 (93.8%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.	92 (82.1%)	0.018^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.
Yes	5 (6.2%)	20 (17.9%)^a a p < 0.05, Chi-Square or Fisher's exact test; data are expressed as the absolute frequency and percentage.

	p-value	Adjusted OR	95% CI
Sex	0.414	0.454	0.068	3.021
Education level	0.011^a a p < 0.05, multinomial logistic regression forward stepwise model.	0.047	0.004	0.503
Marital status	0.134	0.143	0.011	1.826
Smoking	0.998	0.123	0.012	3.213
Histologic type	0.201	0.119	0.005	3.106
Staging	0.315	3.058	0.345	27.109
RT	0.715	0.689	0.094	5.074
CT	0.212	7.793	0.311	195.466

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[1] ⁎Corresponding author. E-mail:paulo_goberlanio@yahoo.com.br (P.G. Silva).