To evaluate clinicopathologic features of head and neck paraganglioma (HNP), identify factors associated with survival and evaluate treatment trends.
Retrospective cohort analysis of 525 patients in the National Cancer Database diagnosed with HNP (2004-2016). Descriptive statistics illustrate baseline features by tumor behavior. Survival was evaluated by Cox proportional hazards modeling. Treatment trends were compared by Wilcoxon nonparametric tests.
Women (63.8%) outnumbered men (36.2%). The most common anatomic site was the carotid body (33.7%). Most tumor behaviors were locally invasive (45.9%) or borderline (37.9%). Distant metastasis was present in 7.1% of patients. Among patients with benign tumors, single modality radiotherapy (aHR 8.19, 95% CI 0.96-70.31), surgery with adjuvant radiotherapy (aHR 19.49; 95% CI 1.73-219.39), and observation (aHR 17.03, 95% CI 1.95-148.42) were associated with worse survival than single modality surgery. Among patients with borderline tumors, governmental insurance (aHR 4.53, 95% CI 1.23-16.71) and high comorbidity scores (aHR 53.45, 95% CI 9.11-313.77) were associated with poor survival. Among patients with invasive tumors, increasing age (60-69 years: aHR 11.62, 95% CI 1.33-101.9; 70-79 years: aHR 20.09, 95% CI 2.15-188.01; ³80 years: aHR 19.43, 95% CI 1.61-233.84, reference: <30 years), distant metastasis (aHR 2.66, 95% CI 1.18-5.99), and positive surgical margins (aHR 3.03, 95% CI 1.07-8.58) were associated with poor survival. Surgery has declined for borderline (ptrend=0.002) and invasive HNP (ptrend=0.009). For borderline HNP, single modality surgery has declined (ptrend=0.018), while single modality radiotherapy has increased (ptrend=0.008). Adjuvant radiotherapy has declined in invasive HNP (ptrend=0.004).
HNP behavior may help guide management and prognosis.