Elective neck dissection and adjuvant therapy in N0 major salivary gland cancer: An analysis of the SEER cancer database.

PURPOSE: High-grade major salivary gland cancer is associated with poor prognostic outcomes, but the role for elective neck dissection (END) for improving survival in high-grade N0 major salivary gland cancer is under debate, especially in the context of planned adjuvant therapy.

METHODS

We performed a secondary analysis of the SEER cancer database for all patients surgically treated for N0 major salivary gland cancer from 2000 to 2022. Our primary outcome was disease-specific survival (DSS), and our secondary outcome was overall survival. We generated multivariable Cox regression models to evaluate the association of END with survival outcomes.

RESULTS

Across the study cohort of 1387 patients, END was independently associated with better DSS (adjusted HR: 0.49, 95% confidence interval (CI): 0.28, 0.83; p < 0.01) in high-grade N0 major salivary gland cancer, but not low-to-intermediate grade N0 major salivary gland cancer (adjusted HR: 0.82, 95% CI: 0.32, 2.08; p = 0.67). END alone (adjusted HR: 0.23, 95% CI: 0.05, 1.07; p = 0.06) or with adjuvant radiotherapy (adjusted HR: 0.42, 95% CI: 0.18, 1.00; p = 0.05) may improve DSS in high-grade T1/T2 N0 disease, while END with adjuvant radiotherapy may be necessary for T3/T4adisease, but these results were inconclusive and require validation.

CONCLUSION

Surgeons may consider END in patients with high-grade N0 major salivary gland cancer but opt for regional surveillance in patients with low-to-intermediate grade disease. END with or without adjuvant radiotherapy may be considered in T1/T2 high-grade N0 major salivary gland cancers, but both modalities are likely necessary in T3/T4 disease; however, further confirmatory studies are needed.