Prognostic models for estimating survival of salivary duct carcinoma: a population-based study.

PURPOSE: In a large salivary duct carcinoma (SDC) cohort, we aimed to investigate the clinical factors influencing their survival outcomes and to further establish prognostic models. METHODS: Data of patients with SDC were extracted from the Surveillance, Epidemiology, and End Results database (1975-2019). A retrospective analysis was conducted to explore the prognostic factors on overall survival (OS) and disease-specific survival (DSS), and corresponding nomograms were established. RESULTS: A steady upward trend in the incidence of SDC was observed over the past four decades. Totally, 399 patients (280 in the training set and 199 in the testing set) were enrolled. Advanced T stage, lymph node metastasis, distant metastasis, and surgery were associated with favorable OS and DSS. Besides, age > 80 years exhibited worse OS. The selected variables above were used to construct nomograms and online web calculators that could accurately predict patient survival. In addition, risk stratification systems were generated to identify low- and high-risk patients. As the risk level increased, the risk of both patient mortality and disease-specific mortality increased. CONCLUSIONS: The SDC incidence was low, but steadily increasing. The proposed prognostic models provided a robust and efficient approach to predict survival and risk stratification in SDC patients.

Translational Insights in the Landscape of Salivary Gland Cancers: Ready for a New Era?

Salivary gland carcinomas (SGCs) are rare neoplasms, representing less than 10% of all head and neck tumors, but they are extremely heterogeneous from the histological point of view, their clinical behavior, and their genetics. The guidelines regarding their treatment include surgery in most cases, which can also play an important role in oligometastatic disease. Where surgery cannot be used, systemic therapy comes into play. Systemic therapy for many years has been represented by polychemotherapy, but recently, with the affirmation of translational research, it can also count on targeted therapy, at least in some subtypes of SGCs. Interestingly, in some SGC histotypes, predominant mutations have been identified, which in some cases behave as "driver mutations", namely mutations capable of governing the carcinogenesis process. Targeting these driver mutations may be an effective therapeutic strategy. Nonetheless, it is not always possible to have drugs suitable for targeting driver mutations-and targeting driver mutations is not always accompanied by a clinical benefit. In this review, we will analyze the main mutations predominant in the various histotypes of SGCs.

Nomograms-based prediction of overall and cancer-specific survivals for patients diagnosed with major salivary gland carcinoma.

BACKGROUND: Major salivary glands carcinoma (MSGC) is a relatively rare cancer with diverse histological types and biological behavior. The treatment planning and prognosis prediction are challenging for clinicians. The aim of the current study was to establish a reliable and effective nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) for MSGC patients. METHODS: Patients pathologically diagnosed with MSGC were recruited from Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation groups (7:3 ratio). Univariate, multivariate Cox proportional hazard models, and least absolute shrinkage and selection operator (LASSO) regression were adopted for the selection of risk factors. Nomograms were developed using R software. The model performance was evaluated by drawing receiver operating characteristic (ROC), overtime C-index curves, and calibration curves. Harrell C-index, areas under the curves (AUC), and Brier score were also calculated. The decision curve analysis (DCA) was conducted to measure the net clinical benefit. RESULTS: A total of 11,362 patients were identified and divided into training (n=7,953) and validation (n=3,409) dataset. Sex, age, race, marital status, site, differentiation grade, American Joint Committee on Cancer (AJCC) stage, T/N/M stage, tumor size, surgery, and histological type were incorporated into the Cox hazard model for OS prediction after variable selection, while all predictors, except for marital status and site, were selected for CSS prediction. For 5-year prediction, the AUC of the nomogram for OS and CSS was 83.5 and 82.7 in the training and validation dataset, respectively. The C-index was 0.787 for OS and 0.798 for CSS in the validation group. The Brier score was 0.0153 and 0.0130 for OS and CSS, respectively. The calibration curves showed that the nomogram had well prediction accuracy. From the perspective of DCA, a nomogram was superior to the AJCC stage and TNM stage in net benefit. In general, the performance of the nomogram was consistently better compared to the AJCC stage and TNM stage across all settings. CONCLUSIONS: The performance of the novel nomogram for predicting OS and CSS of MSGC patients was further verified, revealing that it could be used as a valuable tool in assisting clinical decision-making.

Major and minor salivary gland tumours.

Salivary glands carcinomas are very rare epithelial malignant tumors. In 2013 in Europe, 7800 new diagnoses were estimated, 8.5 % of all head and neck cancer. The last WHO classification (2017) counts more than 20 malignant histotypes, this variety as well as the rarity of some of them needs a skilled pathologist for diagnosis. Surgery remains the mainstay of management followed by radiation in high-grade and high-risk pathological features cases. The intensity modulated radiotherapy (IMRT) should be preferred over conformational radiotherapy techniques as adjuvant and exclusive treatment in advanced cases. Particle radiotherapy (i.e. protons, carbon ions) can have a role in advanced/unresectable disease since it was proved to have better results over photons in loco-regional control both in adenoid cystic carcinoma and in other histotypes. Although chemotherapy is still the most frequent treatment for metastatic patients, several new compounds (i.e. anti-angiogenic agents, tailored agents, checkpoint inhibitors) are under investigation.