Abstract
6082 Background: Salivary gland cancer (SGC) is a rare malignancy and has been understudied in the literature. Given the rarity of SGC, we sought to compare outcomes of SGC within high volume (HV) and low volume (LV) centers, utilizing the National Cancer Database (NCDB). Methods: The NCDB was queried from 2004 to 2014 for SGC using ICD-O-3 codes for the 4 most common histologies: (mucoepidermoid carcinoma (ME), adenoid cystic carcinoma (AdCC), acinic cell carcinoma(ACC), and adenocarcinoma NOS(A)) for consistency. The number of cases treated at each facility was calculated, and the threshold for distinguishing high volume vs. low volume was determined using the 80th percentile of the number of cases treated per facility. Patient characteristics were compared using chi-squared tests and ANOVA. Overall survival was estimated using the Kaplan-Meier method, and was compared using log-rank tests. Statistical analyses were performed using SAS 9.4. Results: There were 31,189 SG patients overall; 16,373 were either ME, AdCC, ACC, or A and were included in the analysis. There were 6534 patients treated in LV (41%) and 9839 in HV (59%). HV centers were more likely to be academic and integrated network cancer programs (p < .001). The median age for LV vs. HV was 61y vs. 58y (p < .001), 49% vs. 47% male (p = .007), and 84% vs. 80% White (p < .001), respectively. Patients presented with slightly more advanced disease at HV, with 24.4% having stage 3-4 disease, vs 23% in LV (p = .004). The majority of patients underwent surgical resection (57% LV vs. 64% HV). HV had more negative margins (59% vs 55%, p < .001), more neck dissections (72% vs. 64%, p < .001), and longer hospital stays (mean 2.21d vs 1.55d, p < .001). More patients in LV received radiation than HV (55% vs. 52%, p < .001), but there was no difference in chemotherapy use (p = 0.650). Patients had better survival (m1 disease excluded) in HV as compared to LV (5-year OS HV 77.4% vs LV 75.5%, HR 0.89, p = 0.002). Conclusions: Our results indicate that survival of SGC is affected by institutional treatment volume and the significant differences in treatment at LV vs. HV institutions urges for the need of better standardization of care.
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