Predictive Factors of Malignancy in Cervical Paragangliomas: A Retrospective Study

Early predictive factors of metastatic cervical paragangliomas (cPG) are lacking.

This multicenter retrospective study included patients with at least one cPG. Metastatic cPG were defined by the histological presence of lymph node metastases or distant metastases. Clinical, radiological, intraoperative, histological, and mutational status characteristics were collected. Predictive factors of metastatic cPG were searched using logistic regression.

Sixty-seven patients were included, corresponding to 86 cPG; 12.8% of these were metastatic. The seven newly identified risk factors were: presence of necrosis (OR = 12.36, 95% CI: [3.03-55.66]), extracapsular extension (OR = 33.42, 95% CI: [2.48-4752.00]), and pathological lymph nodes (OR = 25.00, 95% CI: [3.96-276.07]) on morphological imaging (MRI and/or CT); heterogeneous tumor uptake (OR = 15.5, 95% CI: [2.31-143.68]) and abnormal lymph node uptake (OR = 16.5, 95% CI: [2.04-174.94]) on functional imaging (FDG-PET-CT); invasion of adjacent tissues (OR = 34.63, 95% CI: [3.82-4602.65]) and sacrifice of noble structures (OR = 75.9, 95% CI: [7.99-10230.73]) in patients who underwent surgery.

These risk factors could be combined to promptly identify aggressive cPG and adapt therapeutic strategy.