The prognostic role of comorbidity in salivary gland carcinoma.
ABSTRACT Patients with head and neck cancer are prone to develop significant comorbidity mainly because of the high incidence of tobacco and alcohol abuse, both of which are etiologic and prognostic factors. However, to the authors' knowledge little is known regarding the prognostic relevance of comorbidity in patients with salivary gland cancer.
A retrospective cohort of 666 patients with salivary gland cancer was identified within the Dutch Head and Neck Oncology Cooperative Group database. For multivariate analysis, a Cox proportional hazards model was used to study the effect of comorbidity on overall survival and disease-specific survival.
According to the Adult Comorbidity Evaluation-27 (ACE-27) index, 394 patients (64%) had grade 0 comorbidity, 119 patients (19%) had grade 1 comorbidity, 71 patients (12%) had grade 2 comorbidity, and 29 patients (5%) had grade 3 comorbidity. In multivariate analysis for overall survival, the ACE-27 comorbidity grade was a strong independent prognostic variable. The hazards ratio (HR) of death, including all causes, was 1.5 (95% confidence interval [CI], 1.1-2.1) for patients with ACE-27 grade 1 comorbidity versus grade 0 comorbidity (P < .007). The HR was 1.7 (95% CI, 1.2-2.5) for grade 2 comorbidity (P = .003) and 2.7 (95% CI, 1.5-4.7) for grade 3 comorbidity versus grade 0 comorbidity (P = .001). In the current analysis, ACE-27 comorbidity grade was not an independent prognostic factor for disease-free survival.
To the authors' knowledge, this is the first study concerning the prevalence and relevance of the prognostic comorbidity variable ACE-27 grade in patients with salivary gland cancer. Overall survival, but not disease-free survival, was correlated strongly with ACE-27 grade. Compared with other studies that investigated the effect of comorbidity on patients with head and neck cancer, patients with salivary gland cancer had less comorbidity. Their comorbid status appeared to be reasonably comparable to that of patients with other nonsmoking- and nonalcohol-related cancers.
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ABSTRACT: Refined imaging technology, the use of external beam radiation, neutron beam therapy, and chemotherapy, has altered management strategies for patients with salivary gland malignancies during the past 2 decades. Although treatment remains primarily surgical, optimal therapeutic regimens have yet to be fully realized. The purpose of this investigation is to report our experience with the management of patients with a variety of malignant salivary gland neoplasms that were treated with various combinations of surgery, radiation, and chemotherapy and to review treatment outcome in an effort to identify predictors of survival and locoregional control. The records of all patients with malignant salivary gland tumors presenting for treatment at our institution between 1992 and 2002 were retrospectively reviewed. Variables were collected and outcome measures were defined in terms of overall survival, disease-free survival, and locoregional control. Descriptive statistics were compiled and statistically evaluated. Survival was described using the Kaplan-Meier method. Prognostic factors were assessed using the Cox proportional hazards model. Clinical and reconstructive factors were reviewed. Eighty-five patients (35 males and 50 females) ranging in age from 16 to 89 years (mean, 58.6 years) met the criteria for inclusion in the study. The majority of tumors were located in the parotid gland (n = 42), with a significant minority located in the minor salivary glands (n = 29), followed by the submandibular gland (n = 8) and the sublingual gland (n = 6). Mucoepidermoid carcinoma was the most common neoplasm (n = 40). More than half of the patients presented in early-stage disease (stage I = 36, stage II = 17, stage III = 8, stage IV = 25). All patients were treated with surgery as the primary modality. Neck dissection was performed in 29% of patients, and more than half (56%) were treated with adjuvant external beam radiation therapy to a dose of 50 to 70 Gy. Patients were, in general, immediately reconstructed at the time of ablation using composite free tissue transfer when appropriate, local/regional rotational flaps, or maxillary obturators. The disease-free survival rate and locoregional control rate at 5 years were 77% and 86%, respectively. Stage (P = .0017), grade (P = .00044), cervical lymph node metastasis (P = .03), and age (P = .01) proved to make a statistically significant contribution when describing outcome. Neither site (P = .5), the presence of positive margins (P = .3), nor perineural invasion (P = .7) had a significant impact on survival. The treatment of salivary gland malignancies remains primarily surgical, although adjunctive radiotherapy may play an important role in those patients with advanced-stage disease. This study confirms the contributions of stage, grade, age, and cervical metastasis for describing survival. The benefits of combined modality therapy awaits prospective clinical trials.Journal of Oral and Maxillofacial Surgery 08/2005; 63(7):917-28. · 1.33 Impact Factor
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ABSTRACT: The associated co-morbid diseases present at the time of discovery of adult maturity-onset diabetes mellitus have not hitherto been quantitatively related to the subsequent course of the patients.From existing medical records and other solicited data, complete 5-yr follow-up was obtained for an ‘inception cohort’ of 188 patients who were treated during the years 1959–1962 at the West Haven VA Hospital and whose diabetes was first diagnosed within 6 months before ‘zero time’, which was the date of discharge for the ailment that had provoked hospitalization. A special classification was developed for categorizing the zero-time co-morbidity of the patients as prognostically cogent or non-cogent, and for dividing cogent co-morbidity into vascular and nonvascular types, with functional severity graded as none, moderate, and severe.The fatality rate at 5 yr after zero time was 40 per cent (76/188) for all patients, but distinctive gradients of fatality were noted for age, for type of co-morbidity, and particularly for severity of co-morbidity. The 5-yr fatality rate after zero time was 7 per cent in forty-one patients with no cogent co-morbidity, 33 per cent in seventynine patients with moderate co-morbidity and 69 per cent in sixty-eight patients with severe co-morbidity.Of the sixty-eight patients with severe initial co-morbidity, 53 per cent later died of the same or a related ailment; in the seventy-nine patients with moderate co-morbidity, the analogous death rate was 13 per cent. Death was due to ‘vascular causes’ in 52 per cent of seventy-seven patients who initially had vascular co-morbidity, in 7 per cent of seventy patients with nonvascular co-morbidity, and in 2 per cent of forty-one patients with no cogent co-morbidity. Among 5-yr survivors, the occurrence rate of new vascular events (or ‘diabetic complications’) was directly related to the same features of age and co-morbidity that seemed to affect fatality.These data indicate that the outcome of patients with maturity-onset diabetes mellitus depends on the type and functional severity of the co-morbid diseases present when the diabetes is detected. An appropriate analysis of co-morbidity, although omitted from existing statistical studies of diabetes, is pre-requisite to evaluating the results of different modes of therapy.Journal of Chronic Diseases 10/1974; 27(7-8):387-404.
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ABSTRACT: Parotid gland carcinoma is an infrequent tumor, and series that report on these neoplasms are relatively scarce in the literature. The objective of the current study was to identify prognostic factors in patients with parotid gland carcinoma and to develop a method for defining the probability of recurrence. Patients with parotid gland carcinoma who were treated at the authors' institution from January 1981 through December 2004 and who completed treatment constituted the study group. Disease-free survival was calculated by using the Kaplan-Meier method. Logistic regression analysis was employed to define the recurrence-associated prognostic factors. One hundred twenty-seven patients were included (64 men and 63 women); their mean age was 53 years. Mucoepidermoid carcinoma was diagnosed in 34.6% of patients, adenoid cystic was diagnosed in 15.7% of patients, adenocarcinoma was diagnosed in 14.3% of patients, and acinic cell carcinoma was diagnosed in 9.4% of patients. The median disease-free survival was 8.3 years (95% confidence interval [95% CI], 4.3-12.2 years). Logistic regression analysis confirmed tumor classification, facial nerve palsy, grade of tumor differentiation, patient age, and surgical margins as recurrence-associated factors (P < .00001). Using this model, 3 postoperative risk groups were defined-high-risk, intermediate-risk, and low-risk-that had recurrence frequencies of 71.4%, 43.1%, and 8.8%, respectively (P = .0001). The 5-year disease-free survival rates for these groups were 18.7%, 53.9%, and 99.9%, respectively (P = .00001). In this study, the authors identified several significant prognostic factors. Consequently, they have proposed a prognostic score categorization that allows for a straightforward calculation of the risk of recurrence for a given patient that may help to define therapeutic strategies, target patient counseling, and design future trials.Cancer 05/2007; 109(10):2043-51. · 5.20 Impact Factor