Davide Lombardi1, Michele Tomasoni2,3, Alessio Nicolai2, Alberto Paderno2,3, Alberto Grammatica2, Mara Arcuri2,3, Davide Lancini2, Simonetta Battocchio4, Laura Ardighieri4, Anna Bozzola4, Frida Pittiani5, Davide Farina5, Luca Oscar Redaelli de Zinis6, Piero Nicolai7, Cesare Piazza2,3. 1. Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy. davinter@libero.it. 2. Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy. 3. Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. 4. Unit of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy. 5. Unit of Radiology, ASST Spedali Civili, University of Brescia, Brescia, Italy. 6. Unit of Pediatric Otolaryngology-Head Neck Surgery, Children Hospital, ASST Spedali Civili, Brescia, Italy. 7. Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.
Abstract
PURPOSE: Pleomorphic adenoma (PA) is the most common benign parotid tumor, with a well-known propensity to recur. Many factors have been advocated as prognostic, but there is no consensus on how they affect local control. We studied how PA recurrence-free survival (RFS) may be affected by the most relevant risk factors in a time-to-event analysis, comparing them with those observed in a population of non-PA (NPA). METHODS: Patients undergoing parotidectomy for benign lesions between 2002 and 2018 in a single academic tertiary referral center were included. A description of patients, tumors, and treatment characteristics was performed, highlighting differences between PA and NPA. Analysis of PA RFS and relative risk factors was also conducted. RESULTS: Eight hundred fifty patients underwent parotidectomy for benign lesions, 455 (53.5%) for PA and 57 (6.7%) for NPA. Significant differences between PA and NPA were age at surgery, surgical procedure, and resection margins. Recurrence occurred in 3.1% of PA, with a median disease-free interval of 54 months. 2-, 5-, and 10-year RFS were 99.2, 98.5, and 93.9%, respectively. Age < 18 years (HR = 31.31, p < 0.001), intraoperative tumor spillage (HR = 6.57, p = 0.041), extensive pseudo-capsule interruption (HR = 5.85, p = 0.023), and resection margins < 1 mm (HR = 3.16, p = 0.085) were associated with RFS. CONCLUSION: Patients affected by NPA were significantly older and treated with more conservative surgical procedures compared to those with PA. In PA, younger age, major pseudo-capsule defects, and surgical margins were the most relevant factors affecting local control. These results confirm the importance of an appropriate surgical management and long-term follow-up in PA.
PURPOSE: Pleomorphic adenoma (PA) is the most common benign parotid tumor, with a well-known propensity to recur. Many factors have been advocated as prognostic, but there is no consensus on how they affect local control. We studied how PA recurrence-free survival (RFS) may be affected by the most relevant risk factors in a time-to-event analysis, comparing them with those observed in a population of non-PA (NPA). METHODS: Patients undergoing parotidectomy for benign lesions between 2002 and 2018 in a single academic tertiary referral center were included. A description of patients, tumors, and treatment characteristics was performed, highlighting differences between PA and NPA. Analysis of PA RFS and relative risk factors was also conducted. RESULTS: Eight hundred fifty patients underwent parotidectomy for benign lesions, 455 (53.5%) for PA and 57 (6.7%) for NPA. Significant differences between PA and NPA were age at surgery, surgical procedure, and resection margins. Recurrence occurred in 3.1% of PA, with a median disease-free interval of 54 months. 2-, 5-, and 10-year RFS were 99.2, 98.5, and 93.9%, respectively. Age < 18 years (HR = 31.31, p < 0.001), intraoperative tumor spillage (HR = 6.57, p = 0.041), extensive pseudo-capsule interruption (HR = 5.85, p = 0.023), and resection margins < 1 mm (HR = 3.16, p = 0.085) were associated with RFS. CONCLUSION: Patients affected by NPA were significantly older and treated with more conservative surgical procedures compared to those with PA. In PA, younger age, major pseudo-capsule defects, and surgical margins were the most relevant factors affecting local control. These results confirm the importance of an appropriate surgical management and long-term follow-up in PA.
Authors: M Quer; O Guntinas-Lichius; F Marchal; V Vander Poorten; D Chevalier; X León; D Eisele; P Dulguerov Journal: Eur Arch Otorhinolaryngol Date: 2016-02-10 Impact factor: 2.503
Authors: Konstantinos Mantsopoulos; Michael Koch; Nils Klintworth; Johannes Zenk; Heinrich Iro Journal: Laryngoscope Date: 2014-07-14 Impact factor: 3.325
Authors: Georgios Psychogios; Christopher Bohr; Jannis Constantinidis; Martin Canis; Vincent Vander Poorten; Jan Plzak; Andreas Knopf; Christian Betz; Orlando Guntinas-Lichius; Johannes Zenk Journal: Eur Arch Otorhinolaryngol Date: 2020-08-04 Impact factor: 2.503