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Low- and intermediate-grade, low-stage primary parotid cancer: does a "partial" surgery impair disease control? a
Andrea Galli1,2, Michele Tomasoni3, Emilio Salerno4
1Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy. agalli89@gmail.com.
Purpose:
Primary parotid malignancies are rare and heterogeneous. While comprehensive surgery with postoperative radiotherapy (PORT) is well established for high-grade and/or advanced-stage disease, the optimal management of lower grade, early-stage parotid carcinomas remains debatable due to their indolent behavior and low risk of nodal spread.
Methods:
A multicenter retrospective analysis was conducted across ten tertiary referral centers. Patients with primary parotid carcinomas staged as pT1-T2 cN0/pNx and classified as low/intermediate-grade were included (2000-2020). Surgical procedures were categorized as partial (extracapsular dissection, partial superficial, superficial, selective deep lobe parotidectomy) or comprehensive. Time to recurrence (TTR), recurrence-free survival (RFS) and overall survival (OS) were analyzed.
Results:
A total of 129 patients met the inclusion criteria. Partial surgery was performed in 75.4% of cases, and PORT was administered in 37.8%. The 5-year TTR, RFS and OS was 96.6%, 91.7%, and 94.9%, respectively. Recurrence occurred in 3.9% of patients, with no regional failures and no disease-related deaths. PNI was linked to shorter TTR (HR 17.3, p = 0.002), whereas intermediate grade (HR 3.17, p = 0.035), older age (HR 1.03, p = 0.050), pT2 (HR 2.96, p = 0.045) and PNI (HR 4.68, p = 0.009) were associated with lower RFS. Only age was associated with reduced OS. The extent of surgery and PORT did not significantly influence TTR, RFS or OS.
Conclusions:
Low/intermediate-grade early-stage parotid carcinomas showed excellent oncologic outcomes in our cohort, in which we did not find an association between the extent of surgery performed and relapse or survival. The observed impact of PNI on TTR and RFS may support the use of PORT, according to the most recent ESMO-ASCO guidelines.