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Head and Neck Surgery

Elective Neck Dissection and Adjuvant Radiation in N0 Mucoepidermoid Carcinoma

Wednesday, October 4, 2023
10:03 AM - 10:09 AM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Kush Panara, MD

    Resident Physician
    Department of Otorhinolaryngology, University of Pennsylvania
    Philadelphia, PA, United States

    • Co-Author(s)

  • NS

    Neel R. Sangal, MD

    Resident Physician
    Department of Otorhinolaryngology, Univeresity of Pennsylvania
    Phiiladelphia, PA, United States

  • Karthik Rajasekaran, MD

    Assistant Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, Pennsylvania, United States

    • Senior Author(s)

  • Karthik Rajasekaran, MD

    Assistant Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, Pennsylvania, United States

Disclosure(s):
Kush Panara, MD: No relevant relationships to disclose.
Karthik Rajasekaran, MD: No relevant relationships to disclose.
Introduction: The management of the neck in clinically node negative salivary mucoepidermoid carcinoma (MEC) remains controversial. We aim to evaluate the role of elective neck dissection (END) and adjuvant radiation on disease-free survival in N0 high-grade MEC.

Methods: We performed a retrospective analysis of the of the Surveillance, Epidemiology, and End Results (SEER) database of patients with MEC from 2004-2019. High-grade MEC with pathologically node negative disease were included. Demographic, clinicopathologic, treatment, and outcomes were analyzed. Kaplan-Meir survival curves were used to evaluate five-year disease-free survival (DFS) and five-year overall survival (OS). Multivariate Cox regression analysis was used to control for confounders.

Results: A total of 310 patients with high grade MEC and pathologic N0 disease were identified. The parotid was the most common primary site (266, 86%), followed by submandibular (35, 11%), and sublingual glands (6, 1.9%). Of included patients, 133 (42.9%) were T3-T4 tumors and 212 (68%) received adjuvant radiation. END was performed on 223 (71.9%) of cases. END in T3-T4 high grade MEC led to significant improvements in DFS (0.743 vs 0.340, p < 0.0001) and OS (0.552 vs 0.205, p < 0.0001) as compared to no END. Using multivariate Cox proportional regression to control for age, sex, race, and adjuvant radiation, benefits of END persisted for both DFS (HR = 2.94, p < 0.001) and OS (HR = 1.99, p < 0.04). In addition, adjuvant radiation had no impact on DFS (p = 0.45) or OS (p = 0.91) in T3/T4 tumors. Sub-analysis shows that in patients who received neck dissections, adjuvant radiation had no impact on DFS (p = 0.84) and OS (p = 0.88). These findings persisted when controlling for other variables with multivariate cox proportional regression.

Conclusions: Elective neck dissection significantly improves five-year DFS and five-year OS in T3-T4 pN0 high grade MEC. Although 68% of patients received adjuvant radiation, we show no benefit of this treatment modality on survival outcomes in pN0 high-grade MEC.