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Original Investigation |

A Predictive Nomogram for Recurrence of Carcinoma of the Major Salivary Glands

Safina Ali, MD1; Frank L. Palmer, BA1; Changhong Yu, MS2; Monica DiLorenzo, BA1; Jatin P. Shah, MD1; Michael W. Kattan, PhD2; Snehal G. Patel, MD1; Ian Ganly, MD, PhD1
[+] Author Affiliations
1Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
2Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, Ohio
JAMA Otolaryngol Head Neck Surg. 2013;139(7):698-705. doi:10.1001/jamaoto.2013.3347.
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Published online

Importance  This nomogram quantifies the risk of recurrence in patients with carcinoma of the major salivary glands. It may facilitate patient counseling on prognosis and may help guide management and posttreatment surveillance in these patients.

Objectives  To identify factors predictive of recurrence after primary surgical treatment of carcinoma of the major salivary glands and create a nomogram that could be used to predict the risk of recurrence in an individual patient.

Design  Retrospective case series.

Setting  Single institution tertiary care cancer center.

Patients  After institutional review board approval, 301 patients with previously untreated malignant salivary gland tumors treated at our institution between the years 1985 and 2009 were identified. Among the 301 patients, the median age was 62 (range, 9-89) years and 156 (52%) were male. Patient, tumor, and treatment characteristics were recorded from a retrospective analysis of patient medical charts.

Main Outcomes and Measures  Overall mortality was calculated using the Kaplan-Meier method. Disease-specific mortality and recurrence risk were estimated with cumulative incidence rate. Factors predictive of recurrence were identified using univariate analysis. A Cox proportional hazard model was used to select predictors for the predictive nomogram.

Results  With a median follow-up of 43 (range, 1-264) months, the 5-year overall mortality, disease-specific mortality, and recurrence rate were 30%, 28%, and 33%, respectively. There were 70 recurrences (18 local, 12 regional, and 56 distant). The 5 variables most predictive for recurrence were age, grade, vascular and perineural invasion, and nodal metastasis. These variables were selected to generate the nomogram, which had a high concordance index of 0.85.

Conclusions and Relevance  We introduce a clinically useful nomogram that quantifies the risk of recurrence in carcinomas of the major salivary gland. By quantifying risk for an individual patient, this would enable the clinician to give more accurate prognostic information to the patient resulting in better patient counseling.

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Figure 1.
Flowchart of Categorization of Patients With Major Salivary Gland Disease

Flowchart showing the categorization of 4381 patients with major salivary gland disease treated at Memorial Sloan Kettering Cancer Center from 1985 through 2009. BCC indicates basal cell carcinoma; and SCC, squamous cell carcinoma.

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Figure 2.
Five-Year Recurrence Rate for Patients With Carcinoma of the Major Salivary Glands

The vertical dashed lined indicates the 5-year mark.

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Figure 3.
Sites of Recurrence

Sites of recurrence for patients with carcinoma of the major salivary glands (18 local, 12 regional, and 56 distant).

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Figure 4.
Nomogram and Concordance Index

A, Nomogram for the prediction of recurrence in carcinoma of the major salivary glands. B, Concordance index for predictive nomogram of recurrence in carcinoma of the major salivary glands. The dotted line represents the ideal line where the actual probability of recurrence matches the predicted probability. The solid line represents the observed where the actual probability is slightly different from the predicted.

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Figure 5.
Utility of the Nomogram in 2 Hypothetical Patients

A, Recurrence risk in T1N0 low-grade mucoepidermoid cancer in a 30-year-old man. B, Recurrence risk in a T4N1 high-grade salivary duct cancer in a 60-year-old woman.

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