Evaluation of Surgical Margin Status in Patients With Salivary Gland Cancer

IMPORTANCE Salivary gland cancer comprises a diverse group of histologic types with different biological behavior. Owing to this heterogeneity, the association of margin status and postoperative adjuvant radiotherapy has been poorly studied. OBJECTIVE To examine the association between surgical margin status and oncologic outcomes and the subsequent outcome of adjuvant radiotherapy in patients with salivary gland carcinomas. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from institutional records at Memorial Sloan Kettering Cancer Center from 1985 to 2015. Statistical analysis was completed on October 31, 2020. After exclusions, 837 patients with surgically treated salivary gland carcinoma were identified. Surgical margins and histologic characteristics identified from pathology reports were recorded, with margins classified as negative, dose, and positive, and individual histologic types classified into 3 risk groups: low, intermediate, and high. EXPOSURES The outcome of adjuvant radiotherapy was determined in patients with dose margins with low- and intermediate-risk histologic type and overall pathologic stage I/II disease. MAIN OUTCOMES AND MEASURES Disease-specific survival (DSS) and local recurrence-free survival (LRFS) outcomes were calculated using the Kaplan-Meier method. Multivariable analysis was performed using the Cox proportional hazards regression model. A planned subgroup analysis of patients with close margins was conducted. RESULTS Among the 837 patients identified, 438 were women (52.3%); median age at surgery was 58 years (range, 6-98). A total of 399 tumors (47.7%) originated from major salivary glands, and 438 (52.3%) from minor salivary glands. Margin positivity rates were not different between minor and major salivary gland tumors. Positive surgical margins were identified in 252 patients (30.1%), with nasal cavity/paranasal sinuses and trachea/larynx subsites as the most common sites. Close margins were recorded in 203 patients (24.3%). Adjuvant radiotherapy was administered in 80.5% (103 of 128) of patients with major salivary gland cancer with positive margins, 58.8% (60 of 102) with close margins, and 30.7% (52 of 169) with negative margins and in 70.2% (87 of 124), 36.6% (37 of 101) , and 19.7% (42 of 213) patients with minor salivary gland cancer. With median follow up time of 57 months (range, 1-363 months), patients with positive margins had poorer DSS and LRFS. However, after controlling for overall stage, histologic risk group, and adjuvant radiotherapy, margin status was not a factor associated with poorer DSS or LRFS. In patients with close margins, low-risk and intermediate-risk histologic type, and overall pathologic stage I/II, patients who did not have adjuvant radiotherapy had comparable local control with those who received adjuvant radiotherapy. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that patients with salivary gland cancer who have either dose or positive surgical margins are at increased risk for poorer local control and survival. After controlling for tumor stage, histologic risk group, and the use of adjuvant radiotherapy, margin status was not an independent factor associated with poorer outcome. Subgroup analyses showed that care for patients with close margins with low-risk or intermediate-risk histologic type who have stage I/ II cancers might be managed safely without adjuvant radiotherapy.

Automated summary

This cohort study found that patients with salivary gland cancer with positive or dose surgical margins were at increased risk for poorer local control and survival. However, after controlling for tumor stage, histologic risk group, and the use of adjuvant radiotherapy, margin status was not independently associated with poorer outcome. Subgroup analyses suggest that patients with close margins and low or intermediate-risk histologic type with stage I/II cancers may not require adjuvant radiotherapy.