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Comparative impact of grade on mortality across salivary cancers: A novel, unifying staging system.

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Comparative impact of grade on mortality across salivary cancers: A novel, unifying staging system. Head & neck Ho, A. S., Luu, M., Balzer, B. L., Aro, K., Jang, J. K., Mita, A. C., Scher, K. S., Mallen-St Clair, J., Vasquez, M., Bastien, A. J., Epstein, J. B., Lin, D., Chen, M. M., Zumsteg, Z. S. 2023

Abstract

BACKGROUND: The comparative impact of histologic variants and grade has not been well described.METHODS: Salivary cancer histologies were profiled using hospital and population-based cancer registries. Multivariable models were employed to assess relationships between histology, grade, and survival.RESULTS: On univariate analysis, histologic variants exhibited a wide spectrum of mortality risk (5-year overall survival (OS): 86% (acinic cell carcinoma), 78% (mucoepidermoid carcinoma), 72% (adenoid cystic carcinoma), 64% (carcinoma ex-pleomorphic adenoma), 52% (adenocarcinoma NOS), and 47% (salivary duct carcinoma) (p<0.001). However, on multivariable analysis these differences largely vanished. Worsening grade corresponded with deteriorating survival (5-year OS: 89% [low-grade], 81% [intermediate-grade], 45% [high-grade]; p<0.001), which was upheld on multivariable analysis and propensity score matching. Recursive partitioning analysis generated TNM+G schema (c-index 0.75) superior to the existing system (c-index 0.73).CONCLUSION: Grade represents a primary determinant of salivary cancer prognosis. Integrating grade into stage strengthens current staging systems.

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