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Prognostic Factors in Primary Submandibular Gland Carcinoma: A Systematic Review and Meta-analysis
Eray Uzunoğlu1, Sevilay Karahan2, Tankut Uzun1
1Assisstant Professor, MD, Department of Otorhinolaryngology/Head and Neck Surgery, Çiğli Training and Research Hospital, Bakırçay University, İzmir, Turkey.
Background:
Primary submandibular gland carcinoma is rare and associated with substantial morbidity and mortality. Prognostic factors and optimal management remain controversial because available data are limited and heterogeneous.
Purpose:
We aim to synthesize evidence on prognostic factors associated with survival in subjects with primary submandibular gland carcinoma.
Data Sources:
PubMed, Scopus, and Web of Science were searched from inception to July 2025 using terms related to submandibular gland carcinoma, prognosis, and survival.
Study Selection:
Studies reporting survival outcomes for histologically confirmed primary submandibular gland carcinoma were included without age, sex, or geographic restrictions. Case reports, reviews, studies focused exclusively on other major salivary glands, studies with fewer than 10 subjects, and studies without extractable survival data were excluded. Two reviewers independently selected studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with disagreements resolved by consensus.
Data Extraction And Synthesis:
Data were extracted for demographics, histologic subtype, clinicopathologic variables, treatment, and survival outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed to pool log hazard ratios (logHRs) and 95% CIs for key prognostic factors.
Main Outcomes And Measures:
The primary outcome was overall survival (OS), defined as time from diagnosis to death from any cause.
Results:
A total of 526 unique studies were screened, and 24 studies including 5,050 subjects were eligible. The pooled weighted mean age was 59.5 years; 2,700 subjects (53.5%) were male and 2,350 (46.5%) were female. Adenoid cystic carcinoma was the most frequent histologic subtype, reported in 1,900 subjects (37.6%). Advanced T stage was associated with worse OS (pooled logHR, 0.88; 95% CI, 0.06-1.69; P = .04), as was advanced N stage (pooled logHR, 1.29; 95% CI, 0.50 to 2.09; P = .002). Age, sex, histologic grade, perineural invasion, lymphovascular invasion, and adjuvant radiotherapy were not statistically significantly associated with OS. The mean Newcastle-Ottawa Scale score was 7.9.
Conclusions And Relevance:
Advanced T stage and N stage were the principal adverse prognostic factors for OS. These findings support careful primary tumor and neck assessment for risk stratification, treatment planning, and follow up.