Clinical Features, Treatment Patterns, and Factors Associated with Survival for Head and Neck Paraganglioma

Presentation: P110
Topic: Education / Care Delivery
Type: Poster
Date:
Session:
Authors: Randall J Harley1; Benjamin T Ostrander2; Andrey Finegersh2; Tammy B Pham2; Kareem O Tawfik2; Yin Ren2; Farhoud Faraji2; Rick A Friedman2
Institution(s): 1University of Pittsburgh School of Medicine; 2Department of Surgery, Division of Otolaryngology, University of California San Diego


Objective:

To evaluate clinicopathologic features of head and neck paraganglioma (HNP), identify factors associated with survival and evaluate treatment trends.


Methods:

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.


Results:

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).


Conclusion:

HNP behavior may help guide management and prognosis.