Open AccessLocal Tumor Behavior Associated With Survival Among Patients With Paraganglioma of the Head and Neck
Author(s) -
Harley Randall J.,
Lee Jason H.,
Ostrander Benjamin T.,
Finegersh Andrey,
Pham Tammy B.,
Tawfik Kareem O.,
Ren Yin,
Faraji Farhoud,
Friedman Rick A.
Publication year - 2022
Publication title -
oto open
Language(s) - English
Resource type - Journals
ISSN - 2473-974X
DOI - 10.1177/2473974x221086872
Subject(s) - medicine , hazard ratio , radiation therapy , retrospective cohort study , head and neck cancer , cohort , brain metastasis , metastasis , oncology , cancer , surgery , radiology , confidence interval
Objective The purpose of this study was to evaluate the utility of ICD‐O‐3 –classified local tumor behavior as a prognosticator of head and neck paraganglioma (HNP) outcomes. Study Design Retrospective cohort study. Setting National Cancer Database between 2004 and 2016. Methods This study included patients aged ≥18 years who were diagnosed with HNP. Clinical outcomes and clinicopathologic features were compared with regard to local tumor behavior. Results Our study included 525 patients, of which the majority had HNP classified as locally invasive (45.9%) or borderline (37.9%). The most common anatomic sites involved were the carotid body (33.7%), intracranial regions (29.0%), or cranial nerves (25.5%). Carotid body tumors were exclusively locally invasive, whereas intracranial and cranial nerve HNP were overwhelmingly benign or borderline (94% and 91%, respectively). One‐fourth of patients underwent pathologic analysis of regional lymph nodes, of which the majority were positive for metastasis (80.6%). Metastasis to distant organs was twice as common in patients with locally invasive tumors vs benign (15% vs 7.1). For benign disease, surgery with radiotherapy (adjusted hazard ratio [aHR], 40.45; P =. 006) and active surveillance (aHR, 24.23; P =. 008) were associated with worse survival when compared with surgery alone. For locally invasive tumors, greater age (aHR, 1.07; P <. 0001) and positive surgical margins (aHR, 4.13; P =. 010) were predictors of worse survival, while combined surgery and radiotherapy were predictors of improved survival vs surgery alone (aHR, 0.31; P =. 027). Conclusion While criteria for tumor behavior could not be defined, our results suggest that such a classification system could be used to enhance HNP risk stratification and guide clinical management decisions.