Systematic review of prognostic factors in carcinoma ex pleomorphic adenoma

Seraphina Key; Clemente Chia; Zubair Hasan; Purnima Sundaresan; Raghav C Dwivedi; Faruque Riffat

doi:10.1016/j.oraloncology.2022.106052

Systematic review of prognostic factors in carcinoma ex pleomorphic adenoma

Oral Oncol. 2022 Oct:133:106052. doi: 10.1016/j.oraloncology.2022.106052. Epub 2022 Jul 31.

Authors

Seraphina Key¹, Clemente Chia², Zubair Hasan³, Purnima Sundaresan⁴, Raghav C Dwivedi⁵, Faruque Riffat⁶

Affiliations

¹ Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia. Electronic address: seraphinatmkey@gmail.com.
² St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia; Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3000, Australia.
³ Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, New South Wales, Australia Corner Hawkesbury Road and, Darcy Road, Westmead, New South Wales 2145, Australia.
⁴ Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW 2145, Australia.
⁵ Department of Otolaryngology - Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, London NW1 2BU, United Kingdom.
⁶ Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, New South Wales, Australia Corner Hawkesbury Road and, Darcy Road, Westmead, New South Wales 2145, Australia; Macquarie University Hospital, Macquarie University, NSW 2109, Australia; Chris O'Brien Lifehouse, Camperdown NSW 2050, Australia.

PMID: 35921695
DOI: 10.1016/j.oraloncology.2022.106052

Abstract

Objectives: Carcinoma ex Pleomorphic Adenoma (CXPA) is a rare primary salivary gland malignancy, typically arising from a pre-existing pleomorphic adenoma. This systematic review examines prognostic factors affecting overall survival (OS) in major and minor salivary gland CXPA.

Materials and methods: Systematic review of MEDLINE, Cochrane, Scopus, Web of Science, CINAHL, and Open Grey databases from inception to 31st March 2022 for all English-language literature pertaining to 'carcinoma ex pleomorphic adenoma'. All study types with greater than five patients with CXPA of the major and minor salivary glands were eligible for inclusion.

Results: Of 8143 studies, 39 studies (n = 5637 patients) meeting the inclusion criteria were included. Median OS at one, three, five, and ten years were 90.0 %, 72.0 %, 61.9 %, and 45.0 % respectively for all CXPA. Higher staging, T stage, nodal disease, grading, and invasion ≥ 1.5 mm had worse outcomes. Histological subtype, perineural invasion, and radiotherapy did not demonstrate a consistent trend. Three studies were evaluated to have high risk of bias, and was removed for sensitivity analysis.

Conclusion: Survival outcomes worsen with time for all salivary gland CXPA. Further research on histopathological features and the utility of radiation therapy is required to guide patient selection for more aggressive treatment.

Registration: CRD42021238544 (PROSPERO).

Keywords: Adenoma; Head and Neck Cancer; Pleomorphic; Prognostic Factors; Salivary Gland Neoplasms; Survival Outcomes; Systematic Review.

Publication types

Review
Systematic Review

MeSH terms

Adenocarcinoma* / pathology
Adenoma, Pleomorphic* / pathology
Humans
Prognosis
Salivary Gland Neoplasms* / pathology
Salivary Glands, Minor / pathology