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. 2020 Feb;31(2):295-301.
doi: 10.1016/j.annonc.2019.10.024. Epub 2019 Dec 16.

Development and validation of a clinical prediction-score model for distant metastases in major salivary gland carcinoma

J Lukovic  1 , F A Alfaraj  2 , M L Mierzwa  3 , G N Marta  4 , W Xu  5 , J Su  5 , F Y Moraes  1 , S H Huang  1 , S V Bratman  1 , B O'Sullivan  1 , J J Kim  1 , J G Ringash  1 , J Waldron  1 , J R de Almeida  6 , D P Goldstein  6 , K A Casper  7 , A J Rosko  7 , M E Spector  7 , L P Kowalski  8 , A Hope  1 , A Hosni  9
Affiliations
Free article

Development and validation of a clinical prediction-score model for distant metastases in major salivary gland carcinoma

J Lukovic et al. Ann Oncol. 2020 Feb.
Free article

Abstract

Background: The most common pattern of failure in major salivary gland carcinoma (SGC) is development of distant metastases (DMs). The objective of this study was to develop and validate a prediction score for DM in SGC.

Patients and methods: Patients with SGC treated curatively at four tertiary cancer centers were divided into discovery (n = 619) and validation cohorts (n = 416). Multivariable analysis using competing risk regression was used to identify predictors of DM in the discovery cohort and create a prediction score of DM; the optimal score cut-off was determined using a minimal P value approach. The prediction score was subsequently evaluated in the validation cohort. The cumulative incidence and Kaplan-Meier methods were used to analyze DM and overall survival (OS), respectively.

Results: In the discovery cohort, DM predictors (risk coefficient) were: positive margin (0.6), pT3-4 (0.7), pN+ (0.7), lymphovascular invasion (0.8), and high-risk histology (1.2). High DM-risk SGC was defined by sum of coefficients greater than two. In the discovery cohort, the 5-year incidence of DM for high- versus low-risk SGC was 50% versus 8% (P < 0.01); this was similar in the validation cohort (44% versus 4%; P < 0.01). In the pooled cohorts, this model performed similarly in predicting distant-only failure (40% versus 6%, P < 0.01) and late (>2 years post surgery) DM (22% versus 4%; P < 0.01). Patients with high-risk SGC had an increased incidence of DM in the subgroup receiving postoperative radiation therapy (46% versus 8%; P < 0.01). The 5-year OS for high- versus low-risk SGC was 48% versus 92% (P < 0.01).

Conclusion: This validated prediction-score model may be used to identify SGC patients at increased risk for DM and select those who may benefit from prospective evaluation of treatment intensification and/or surveillance strategies.

Keywords: distant metastases; head and neck cancer; prediction score; salivary gland cancer.

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