Abstract：
OBJECTIVE: We aim to evaluate the role of elective neck dissection (END) and adjuvant radiation on survival in N0 high-grade mucoepidermoid carcinoma (MEC).
METHODS: Retrospective cohort study.
METHODS: National Cancer Institute\'s Surveillance, Epidemiology, and End Results (SEER) database.
METHODS: All patients diagnosed with high-grade MEC with node-negative disease (N0) from 2004 to 2018 were included. Demographic, clinicopathologic, treatment, and outcomes were analyzed. Kaplan-Meier survival curves were used to evaluate 5-year disease-specific survival (DSS) and 5-year overall survival (OS). Multivariate Cox regression analysis was used to control for confounders.
RESULTS: A total of 310 patients with high-grade MEC and N0 (clinical and pathologic) disease were identified. The parotid was the most common primary site (266, 86%). Of included patients, 133 (42.9%) were T3-T4 tumors and 212 (68%) received adjuvant radiation. END was performed on 223 (71.9%) of cases. END in T3-T4 high-grade MEC led to significant improvements in DSS (74.3% vs 34.0%, P < .01) and OS (55.2% vs 20.5%, P < .01) as compared to no END. Subanalysis shows that in patients who received neck dissections and were pathologic N0, adjuvant radiation had no impact on DSS (84.0% vs 72.1%, P = .45) and OS (52.1% vs 55.8%, P = .91). Benefits persisted when controlling for confounders using multivariate Cox proportional regression.
CONCLUSIONS: Patients with T3-T4 high-grade MEC who underwent END and found to be pathologically node-negative (pN0) had significantly improved 5-year DSS and 5-year OS than patients who were cN0 and did not undergo END. Importantly, although 68% of patients received adjuvant radiation, we show no benefit of this treatment modality on outcomes in pN0 high-grade MEC.
METHODS: Retrospective cohort study.
METHODS: National Cancer Institute\'s Surveillance, Epidemiology, and End Results (SEER) database.
METHODS: All patients diagnosed with high-grade MEC with node-negative disease (N0) from 2004 to 2018 were included. Demographic, clinicopathologic, treatment, and outcomes were analyzed. Kaplan-Meier survival curves were used to evaluate 5-year disease-specific survival (DSS) and 5-year overall survival (OS). Multivariate Cox regression analysis was used to control for confounders.
RESULTS: A total of 310 patients with high-grade MEC and N0 (clinical and pathologic) disease were identified. The parotid was the most common primary site (266, 86%). Of included patients, 133 (42.9%) were T3-T4 tumors and 212 (68%) received adjuvant radiation. END was performed on 223 (71.9%) of cases. END in T3-T4 high-grade MEC led to significant improvements in DSS (74.3% vs 34.0%, P < .01) and OS (55.2% vs 20.5%, P < .01) as compared to no END. Subanalysis shows that in patients who received neck dissections and were pathologic N0, adjuvant radiation had no impact on DSS (84.0% vs 72.1%, P = .45) and OS (52.1% vs 55.8%, P = .91). Benefits persisted when controlling for confounders using multivariate Cox proportional regression.
CONCLUSIONS: Patients with T3-T4 high-grade MEC who underwent END and found to be pathologically node-negative (pN0) had significantly improved 5-year DSS and 5-year OS than patients who were cN0 and did not undergo END. Importantly, although 68% of patients received adjuvant radiation, we show no benefit of this treatment modality on outcomes in pN0 high-grade MEC.
摘要：
目的：我们旨在评估选择性颈淋巴结清扫术（END）和辅助放疗对N0高级别粘液表皮样癌（MEC）患者生存的影响。
方法：回顾性队列研究。
方法：国家癌症研究所的监测，流行病学,和结束结果(SEER)数据库。
方法：纳入2004年至2018年诊断为淋巴结阴性疾病（N0）的高级别MEC患者。人口统计,临床病理,治疗,并对结果进行了分析。Kaplan-Meier生存曲线用于评估5年疾病特异性生存（DSS）和5年总生存（OS）。多因素Cox回归分析用于控制混杂因素。
结果：共确定310例高度MEC和N0（临床和病理）疾病患者。腮腺是最常见的原发部位（266，86％）。在包括患者中，133例（42.9%）为T3-T4肿瘤，212例（68%）接受辅助放疗。对223例(71.9%)进行了END。T3-T4高级MEC的结束导致DSS的显着改善（74.3％对34.0％，P<.01）和OS（55.2%对20.5%，P<0.01）与无END相比。亚分析显示，在接受颈淋巴结清扫和病理性N0的患者中，辅助辐射对DSS没有影响(84.0%vs72.1%，P=.45）和OS（52.1%对55.8%，P=.91）。当使用多变量Cox比例回归控制混杂因素时，益处仍然存在。
结论：T3-T4高级别MEC患者进行END并发现病理淋巴结阴性（pN0），其5年DSS和5年OS比cN0且未进行END的患者明显改善。重要的是,尽管68%的患者接受了辅助放疗，我们显示这种治疗方式对pN0高级别MEC的结局没有益处.
方法：回顾性队列研究。
方法：国家癌症研究所的监测，流行病学,和结束结果(SEER)数据库。
方法：纳入2004年至2018年诊断为淋巴结阴性疾病（N0）的高级别MEC患者。人口统计,临床病理,治疗,并对结果进行了分析。Kaplan-Meier生存曲线用于评估5年疾病特异性生存（DSS）和5年总生存（OS）。多因素Cox回归分析用于控制混杂因素。
结果：共确定310例高度MEC和N0（临床和病理）疾病患者。腮腺是最常见的原发部位（266，86％）。在包括患者中，133例（42.9%）为T3-T4肿瘤，212例（68%）接受辅助放疗。对223例(71.9%)进行了END。T3-T4高级MEC的结束导致DSS的显着改善（74.3％对34.0％，P<.01）和OS（55.2%对20.5%，P<0.01）与无END相比。亚分析显示，在接受颈淋巴结清扫和病理性N0的患者中，辅助辐射对DSS没有影响(84.0%vs72.1%，P=.45）和OS（52.1%对55.8%，P=.91）。当使用多变量Cox比例回归控制混杂因素时，益处仍然存在。
结论：T3-T4高级别MEC患者进行END并发现病理淋巴结阴性（pN0），其5年DSS和5年OS比cN0且未进行END的患者明显改善。重要的是,尽管68%的患者接受了辅助放疗，我们显示这种治疗方式对pN0高级别MEC的结局没有益处.
