| Title: |
Oncologic Safety of Close Margins in Patients With Low- to Intermediate-Grade Major Salivary Gland Carcinoma |
| Authors: |
Sajisevi, Mirabelle; Nguyen, Kenny; Callas, Peter; Holcomb, Andrew J.; Vural, Emre; Davis, Kyle P.; Thomas, Carissa M.; Plonowska-Hirschfeld, Karolina A.; Stein, John S.; Eskander, Antoine; Kakarala, Kiran; Enepekides, Danny J.; Hier, Michael P.; Ryan, William R.; Asarkar, Ameya A.; Aulet, Ricardo; Bell, Rebecca K.; Blasco, Michael A.; Bowmaster, Vanessa B.; Burruss, Clayton P.; Chung, Jeffson; Chan, Kimberly; Chang, Brent A.; Coffey, Charles S.; Cognetti, David M.; Cooper, Dylan J.; Cordero, Joehassin; Donovan, John; Du, Yue; Dundar, Yusuf; Dedivitis, Rogerio A.; Edwards, Heather A.; Erovic, Boban M.; Feinberg, Philip A.; Garvey, Emily A.; Goldstein, David P.; Goodman, Joseph F.; Goulart, Rafael N.; Goyal, Neerav; Grasl, Stefan; Giurintano, Jonathan P.; Gupta, Nikita; Habib, Andy M.; Hackman, Trevor G.; Hara, Jared H.; Henson, Christina; Hinni, Michael L.; Hua, Nadia; Johnson-Obaseki, Stephanie; Juloori, Aditya; Kalman, Noah S.; Kejner, Alexandra E.; Khaja, Sobia F.; Ku, Jamie A.; Lambert, Arnaud; Luu, Bao K.; Magliocca, Kelly R.; dos Santos, Luiz R. Medina; Michael, Cara; Miles, Brett A.; de Melo, Giulianno Molina; Moore, Michael G.; Morand, Gregoire B.; Moura, Kauê; Mukdad, Laith; Noroozi, Hesameddin; Patel, Rusha; Paydarfar, Joseph A.; Sadeghi, Nader; Savaria, Fabrice N.; Schmitt, Nicole C.; Shapiro, Justin; Shaver, Timothy B.; Stoeckli, Sandro J.; St. John, Maie; Stokes, William Alvo; Sulibhavi, Anita; Tasoulas, Jason; Vendra, Varun; Vinh, Daniel B.; Virgen, Celina G.; Wooten, Christian; Woody, Neil M.; Young, Geoffrey D. |
| Source: |
JAMA Otolaryngology–Head & Neck Surgery, 150(2) |
| Publisher Information: |
American Medical Association (AMA) |
| Publication Year: |
2024 |
| Collection: |
Carolina Digital Repository (UNC - University of North Carolina) |
| Subject Terms: |
study of patients; independent factors; cohort; submandibular gland carcinoma; oncological safety; lymphovascular invasion; margin; marginalized groups; relevance; associated with decreased risk; positive margins; months; Main; patients; median; recurrence-free survival; low-grade tumors; observations; analysis; local recurrence rate; R0 margins; diagnosis; evidence; R1; supportive evidence; salivary gland sections; measurements; study population; R0; distance |
| Description: |
Importance: Postoperative radiation therapy for close surgical margins in low- to intermediate-grade salivary carcinomas lacks multi-institutional supportive evidence. Objective: To evaluate the oncologic outcomes for low- and intermediate-grade salivary carcinomas with close and positive margins. Design, Setting, and Participants: The American Head and Neck Society Salivary Gland Section conducted a retrospective cohort study from 2010 to 2019 at 41 centers. Margins were classified as R0 (negative), R1 (microscopically positive), or R2 (macroscopically positive). R0 margins were subclassified into clear (>1 mm) or close (≤1 mm). Data analysis was performed from June to October 2023. Main Outcomes and Measures: Main outcomes were risk factors for local recurrence. Results: A total of 865 patients (median [IQR] age at surgery, 56 [43-66] years; 553 female individuals [64%] and 312 male individuals [36%]) were included. Of these, 801 (93%) had parotid carcinoma and 64 (7%) had submandibular gland carcinoma, and 748 (86%) had low-grade tumors and 117 (14%) had intermediate-grade tumors, with the following surgical margins: R0 in 673 (78%), R1 in 168 (19%), and R2 in 24 (3%). Close margins were found in 395 of 499 patients with R0 margins (79%), for whom margin distances were measured. A total of 305 patients (35%) underwent postoperative radiation therapy. Of all 865 patients, 35 (4%) had local recurrence with a median (IQR) follow-up of 35.3 (13.9-59.1) months. In patients with close margins as the sole risk factor for recurrence, the local recurrence rates were similar between those who underwent postoperative radiation therapy (0 of 46) or observation (4 of 165 [2%]). Patients with clear margins (n = 104) had no recurrences. The local recurrence rate in patients with R1 or R2 margins was better in those irradiated (2 of 128 [2%]) compared to observed (13 of 64 [20%]) (hazard ratio [HR], 0.05; 95% CI, 0.01-0.24). Multivariable analysis for local recurrence found the following independent factors: age at ... |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| Relation: |
https://cdr.lib.unc.edu/downloads/ks65hs829?file=thumbnail; https://cdr.lib.unc.edu/downloads/ks65hs829 |
| DOI: |
10.17615/8sj3-t887 |
| Availability: |
https://doi.org/10.17615/8sj3-t887; https://cdr.lib.unc.edu/downloads/ks65hs829?file=thumbnail; https://cdr.lib.unc.edu/downloads/ks65hs829 |
| Rights: |
http://rightsstatements.org/vocab/InC/1.0/ |
| Accession Number: |
edsbas.90D3BBA9 |
| Database: |
BASE |