Rethinking the Definition of High Risk in Pediatric Salivary Gland Carcinoma.

OBJECTIVE: Indications for adjuvant radiation in pediatric salivary gland carcinoma rely on high-risk criteria extrapolated from adult data. We sought to determine whether adult-derived high-risk criteria were prognostic in children aged ≤21 years or young adults aged 22 to 39 years. STUDY DESIGN: Cross-sectional analysis of a hospital-based national registry. SETTING: Patients were identified from the National Cancer Database between 2004 and 2015. METHODS: High-risk criteria were defined as adenoid cystic histology, intermediate/high grade, T3/T4, positive margins, and/or lymph node involvement. Exact matching was used to adjust for differences in baseline characteristics between pediatric and young adult patients. RESULTS: We identified 215 pediatric patients aged ≤21 years, 317 patients aged 22 to 30 years, and 466 patients aged 31 to 39 years. Within the pediatric cohort, there was no significant difference in overall survival (OS) between low- and high-risk groups (5-year OS, 100% vs 98.5%; P = .29). In contrast, within the young adult cohorts, there was a significant difference in OS between low- and high-risk groups in patients aged 22 to 30 years (5-year OS, 100% vs 96.1%; P = .01) and 31 to 39 years (5-year OS, 100% vs 88.5%; P < .001). When high-risk patients were matched 1:1 on high-risk criteria and race, pediatric patients were associated with better OS than those aged 22 to 30 years (P = .044) and those aged 31 to 39 years (P = .005). CONCLUSION: Children have excellent OS, irrespective of adult-derived high-risk status. These findings underscore the need to understand how age modifies clinicopathologic risk factors.

Survival of Patients With Non-Rhabdomyosarcoma Soft Tissue Sarcomas of the Head and Neck.

OBJECTIVE: To evaluate factors associated with overall survival (OS) of patients with non-rhabdomyosarcoma soft tissue sarcomas of the head and neck. STUDY DESIGN: Retrospective cohort study. METHODS: The National Cancer Database was queried for cases of non-rhabdomyosarcoma soft tissue sarcomas of the head and neck between 2004 and 2014. Cases were categorized according to the World Health Organization classification of soft tissue tumors. A multivariable Cox proportional hazards model was used to evaluate associations with OS. RESULTS: A total of 4,555 patients (63.6% male, 36.4% female, mean age 59.6 years) met inclusion criteria. The majority of tumors were classified as miscellaneous (35.9%), followed by vascular (20.1%), smooth muscle (13.5%), fibroblastic/myofibroblastic (12.1%), peripheral nerve (8.5%), adipocytic (7.4%), and undifferentiated (2.5%) sarcomas. The mean follow-up was 37.9 months, and overall mortality (MR) was 45.3%. The best prognosis was seen with fibroblastic/myofibroblastic sarcomas (MR = 20.6%, P < .001), whereas vascular sarcomas had the worst prognosis (MR = 67.6%, P < .001). Resection with clear margins had better OS than microscopically positive margins (hazard ratio [HR] = 1.43, P < .001) or grossly positive margins (HR = 2.97, P < .001). Radiation therapy was associated with better OS than no radiation (HR = 0.86, P = .001). CONCLUSION: Non-rhabdomyosarcoma soft tissue sarcomas of the head and neck are associated with significant mortality. OS differs based on histologic subcategorization. Resection of the primary tumor with clear margins demonstrates improved OS for all histologies, suggesting this modality remains the preferred primary treatment when feasible. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E500-E508, 2021.

Beyond positive or negative: variability in daily parent-adolescent interaction quality is associated with adolescent emotion dysregulation.

Previous work on the contribution of family environments to adolescent emotion dysregulation has tended to focus on broad parenting characteristics (such as warmth); however, it is possible that day-to-day variability in parenting may also relate to emotion dysregulation. The current study sought to test whether inconsistency in the quality of daily parent-youth interactions related to multiple indices of emotion dysregulation in adolescents. Two-hundred-twenty-two adolescents (ages 13-16; 53% female) participated with one parent. Adolescents completed 14-days of diary reporting on the quality of interactions with their parent (negative/neutral/positive) and their emotion dysregulation experiences for each day. Analyses reveal that, beyond the effects of average interaction quality, adolescents with greater variability in the quality of their interactions with their parent reported greater average emotion dysregulation across the days of diary recording and demonstrated greater variability in their ratings of daily emotion dysregulation. Findings were not accounted for by parental warmth or hostility, parent-reported trait-level emotion regulation, or day-level associations between study variables. In these ways, greater variability - and not merely greater negativity - during interactions between parents and adolescents was related to adolescent emotion dysregulation, suggesting that consistency in parent-adolescent relationships may be an important dimension of psychosocial risk to consider within families.

Family obligations and asthma in youth: The moderating role of socioeconomic status.

OBJECTIVE: Fulfilling family obligations-providing instrumental help to and spending time with family-is a common aspect of family relationships. However, whether fulfilling these obligations links with physical health remains unclear. In this study, we investigated whether fulfilling family obligations was associated with asthma outcomes among youth, and whether these associations differed depending on family socioeconomic status (SES). METHOD: Participants were 172 youth, 8 to 17 years of age (Mage = 12.1; 54% boys) who had been physician-diagnosed with asthma and reported on family-obligation frequency; completed the Asthma Control Test (ACT; Nathan et al., 2004), a clinical measure of asthma control; and completed a measure of airway inflammation (i.e., fractional exhaled nitric oxide). Parents also completed the ACT in reference to their asthmatic children and reported on family income. RESULTS: Fulfilling family obligations was not associated with asthma outcomes (ßs < .14, ps > .075). However, SES (family income) interacted with family obligations, such that fulfilling family obligations was associated with greater airway inflammation (interaction term ß = -.17, p = .023) and poorer parent-reported asthma control (interaction term ß = .15, p = .039), only among youth from lower SES backgrounds. Exploratory analyses suggest that these interactions were robust against covariates and were largely consistent across age and the two dimensions of family-obligation behaviors. CONCLUSION: Findings from this study suggest that among youth from lower SES backgrounds, engaging in more frequent family-obligation behaviors may have negative repercussions in terms of their asthma. (PsycINFO Database Record