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Objectives: Given limited data availability on distant metastasis (DM) in major salivary gland (MSG) malignancy presentation, we aimed to evaluate the rate, histologic patterns, location, and predictors of DM at first MSG cancer presentation and suggest potential implications on diagnostic workup. Study Design: Retrospective cohort. Setting: Commission on Cancer–accredited hospitals. Methods: We included patients in the National Cancer Database (2010-2016) with MSG malignancy. Site and rate of DM were stratified by histologic subtype. Factors predictive of DM at presentation were determined by multivariate regression analysis. Survival analyses were conducted via the Kaplan-Meier method, log-rank test, and Cox regression analysis. Results: Of 5776 patients with MSG carcinoma, 333 (5.8%) presented with DM. The most common DM site was the lung (57.1%), followed by bone (46.8%) and liver (19.5%). DM was most common in adenocarcinoma–not otherwise specified (15.1%, 132/874) and salivary duct carcinoma (10.4%, 30/288). High-grade mucoepidermoid carcinoma had the highest rate of lung metastases (81.6%, 31/38). Conversely, myoepithelial carcinoma had the highest rate of bone metastases (85.7%, 6/7). DM at presentation was independently associated with an increased mortality risk (hazard ratio, 1.62; 95% CI, 1.40-1.90). Conclusion: We identified a DM rate of 5.8% in MSG malignancy at presentation. Overall 43% of patients presented without DM to the lung but with DM to the bones, liver, and/or brain. The most common metastatic sites differed by tumor histology. Staging with computed tomography neck and chest alone may fail to detect sites of DM; this work can be used for patient counseling in the clinical setting. [ABSTRACT FROM AUTHOR]

Objectives: To describe disease characteristics and treatment and to analyze survival and mortality for extranodal mantle cell lymphoma (MCL) of the head and neck. Methods: Patients with extranodal MCL—excluding primary sites in the salivary glands, eye, and adnexa—were identified from the Surveillance, Epidemiology, and End Results (SEER) 18 Registries (2000-2015). Overall survival (OS) and cumulative incidence of MCL and non-MCL mortality were calculated. Factors associated with MCL and non-MCL mortality were analyzed with cause-specific hazard models. Results: Five hundred nine patients met criteria for descriptive analysis and 294 patients met criteria for survival analysis, with a median follow-up of 58 months. The most common sites for MCL were the oropharynx (66.0%), nasopharynx (19.1%), and oral cavity (8.4%). The most common treatment received was chemotherapy alone (48.9%), followed by chemoradiation therapy (16.9%), and radiation therapy alone (10.4%). The proportion of cases diagnosed as early-stage disease ranged from 31% of sinonasal MCLs to 83% of laryngeal MCLs. At 5 years, OS was 63% (95% CI: 57%-69%). There was no significant difference in OS (P =.79), cumulative incidence of MCL mortality (P =.76), or cumulative incidence of non-MCL mortality (P =.98) by anatomic site. Comparing early-stage to late-stage disease, there was no significant difference in OS (P =.38), cumulative incidence of MCL mortality (P =.07), or cumulative incidence of non-MCL mortality (P =.14). Multivariate analysis showed increased hazard of MCL mortality for patients that were older or that presented with stage III or stage IV disease. Conclusion: The oropharynx is the most common subsite of head and neck MCLs, followed by the nasopharynx. Primary head and neck MCLs appear to present at an earlier stage than MCLs of other regions. In particular, laryngeal and hypopharyngeal MCLs may present as stage I or II disease. [ABSTRACT FROM AUTHOR]

Objective: To assess knowledge regarding head and neck cancers (HNCs) in 2020, factors associated with knowledge of the role of human papillomavirus (HPV) in HNCs, and factors associated with exposure to Oral, Head and Neck Cancer Awareness Week (OHANCAW). Study Design: Cross-sectional survey. Setting: Online. Methods: The survey was distributed to 517 participants via a paid panel and utilized US Census–built quotas to represent the US population. Results: Participants surpassed 50% awareness rates in only 5 of 10 (50.0%), 2 of 6 (33.3%), and 5 of 9 (55.5%) preselected answer choices for subsites, risk factors, and signs/symptoms of HNCs, respectively. Knowledge of HPV's role in oropharyngeal cancer was also low, at 30.6%. However, of the controlled variables, exposure to OHANCAW was closely associated with knowledge of HPV's role in HNC (odds ratio, 10.25; 95% CI, 5.36-19.62). Women and elderly individuals were less likely to be exposed to OHANCAW, while those with higher education, those who drink heavily (>4 drinks/d), and current but not former tobacco users were more likely to be exposed. Conclusions: Knowledge of HNCs and the causal role of HPV remains suboptimal, though our results suggest that OHANCAW remains a viable educational pathway. However, certain at-risk populations, such as former smokers and older individuals, whom we may not be effectively reaching and screening, represent a priority for future outreach efforts. [ABSTRACT FROM AUTHOR]

Objective: In 2014, the Radiation Therapy Oncology Group 1221 trial was initiated to analyze whether surgery with risk-based radiation therapy or chemoradiation therapy was superior to chemoradiation therapy alone in patients with clinically staged T1-2N1-2bM0 HPV-negative oropharyngeal squamous cell carcinoma. However, the study was prematurely terminated. Given the lack of a randomized controlled trial, we retrospectively approached the same question using large national cancer databases.Study Design: Retrospective cohort study.Setting: The National Cancer Database and Surveillance, Epidemiology, and End Results (SEER) program from 2010 to 2016.Methods: We identified 3004 patients in the National Cancer Database and 670 patients in the SEER database. Statistical techniques included Kaplan-Meier survival analysis, binary and multinomial logistic regressions, Cox proportional hazard regressions, and inverse propensity score weighting.Results: On weighted multivariable Cox regression, patients recommended to receive frontline surgery had improved overall survival as compared with those recommended to receive chemoradiation therapy alone (hazard ratio [HR], 0.77; 95% CI, 0.68-0.86). On post hoc multivariable analysis based on therapy actually received, frontline surgery with adjuvant chemoradiation therapy was associated with improved overall survival (HR, 0.59; 95% CI, 0.50-0.71) as compared with chemoradiation therapy without surgery. Analysis of the SEER cohort revealed improved overall survival (HR, 0.69; 95% CI, 0.54-0.87) and head and neck cancer-specific survival (HR, 0.59; 95% CI, 0.41-0.84) in patients recommended to receive frontline surgery over chemoradiation therapy alone.Conclusion: Our findings support the use of surgery with risk-based addition of adjuvant therapy in patients with cT1-2N1-2bM0 HPV-negative oropharyngeal cancer. [ABSTRACT FROM AUTHOR]

Objective: To describe malpractice payments made on behalf of otolaryngologists, analyze trends over time, and test the association of payment amount with severity of alleged malpractice and patient age. Study Design: Retrospective cross-sectional analysis. Setting: National Practitioner Data Bank. Subjects and Methods: This study comprised all payments made on behalf of otolaryngologists from 1991 to 2018 that were reported to the National Practitioner Data Bank. Descriptive statistics were calculated within and across years. Trends in payments were analyzed with the Mann-Kendall test. Generalized linear regression was utilized to test for association of payment amount with severity of the alleged injury and patient age. Results: From 1991 to 2018, there was a significant decrease in the number of payments (272 to 81) and number of otolaryngologists on whose behalf payments were made (250 to 77). Mean and median payments increased significantly from $248,848 to $420,386 and from $96,813 to $275,000, respectively. By severity of alleged injury, mean payments ranged from $39,755 (95% CI, $20,957-$75,412) for insignificant injury to $754,349 (95% CI, $624,847-$910,692) for patients who were left quadriplegic, sustained brain damage, or required lifelong care. By patient age, mean payments for patients ≥60 years old were $191,465 (95% CI, $159,880-$229,292) versus $247,878 (95% CI, $209,416-$293,402) for patients aged 20 to 39 years and $232,225 (95% CI, $197,691-$272,793) for patients aged 40 to 59 years. Conclusion: The annual number and total value of malpractice payments decreased, while the annual mean and median payments increased. Payment amount was associated with severity of alleged malpractice and patient age. [ABSTRACT FROM AUTHOR]

Objectives: Determine rate of preoperative biopsy in parotid malignancies, identify factors associated with its use, and its association with surgical margins.Study Design: Retrospective cohort.Setting: Commission on Cancer-Accredited Institutions.Subjects and Methods: We included 5533 patients treated surgically for a parotid malignancy 2004-2014 in the National Cancer Database. Chi-squared tests, univariable, and multivariable logistic regressions were used to evaluate predictors of preoperative biopsy (defined as needle, aspiration, or incisional), and associate biopsy with surgical margins.Results: Preoperative biopsy was utilized in 26.0% of patients. Biopsy was more likely in patients >60 years (odds ratio [OR]: 1.19, P = .035), advanced clinical T stage (vs. T1,T2 OR: 1.23, P = .009; T3 OR: 1.26, P = .026; T4A OR: 2.05, P < .001), advanced clinical N stage (vs. N0, N1: OR: 1.39, P = .013; N2/3: OR: 1.63, P < .001), in academic centers (OR: 1.18, P < .024), and in higher volume centers (vs. low, medium OR: 1.28, P = .002; high OR: 2.16, P < .001). Biopsy use increased over time (vs. 2004-2006, 2007-2010 OR: 1.20, P = .047; 2011-2014 OR: 1.39, P < .001). Biopsy was associated with a reduced risk of positive margins in patients with clinical T1 stage (OR: 0.70, P = .012), and younger than 61 (OR: 0.79, P = .036).Conclusion: The national rate of preoperative biopsy in parotid malignancy is low at 26.0%, but has increased over time. Preoperative biopsy is associated with a reduced risk of positive margins in younger patients and those with early clinical stage, suggesting its increased use may improve surgical outcomes and decrease reoperation or adjuvant therapy in these subgroups of patients.Level Of Evidence: 3 Laryngoscope, 130:1450-1458, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To characterize patients undergoing laryngeal transoral robotic surgery (TORS) and compare to open partial surgery and transoral laser microsurgery (TLM) in achieving negative margins, requiring adjuvant radiation, and overall survival.Study Design: Retrospective database analysis.Methods: Early-stage (T1/2) laryngeal squamous cell carcinoma patients from the National Cancer Database. Univariable and multivariable logistic and Cox regressions were used to identify predictors.Results: There were 1,780 patients included in the study (186 [10.4%] = TORS; 523 [29.4%] = open surgery; 1,071 [60.2%] = TLM). TORS was more commonly treated at academic centers (68.8% = open surgery, 53.9% = TLM, 71.0% = TORS; P < .001) and had more T2 (52.7% = TORS, 46.7% = open surgery, 20.5% = TLM; P < .001) and N-positive disease (26.9% = TORS, 19.5% = open surgery, 5.5% = TLM; P < .001). Surgical approach was significantly associated with margin status (positive margin rates: TORS = 17.4%, TLM = 20.0%, open surgery = 13.8%) between open surgery and TLM in multivariable analysis (compared to open surgery, TLM: 1.63 [1.12-2.38], TORS: 1.18 [0.72-1.94]; P = .04). Surgical approach was not associated with receipt of adjuvant radiation (compared to open surgery, TLM: 1.52 [1.04-2.24], TORS: 1.56 [0.97-2.49]; P = .05). It was not associated with margins or adjuvant radiation in supraglottic patients. TORS had the highest 5-year overall survival, although the survival for TLM was similar (68.7% and 64.8%, respectively), and both were higher than that of open surgery (59.1%; P = .01). In multivariable Cox regression for supraglottic patients, there was no observed difference between TORS and open surgery (compared to TORS, open surgery: 1.44 [0.93-2.24]; P = .25).Conclusions: On multivariable analysis, there was no observed difference in margin status in TORS patients compared to TLM and open surgery (in both the total cohort and supraglottic subgroup). Similarly there was no observed difference in necessitating adjuvant radiation. In Cox regression, there was no observed difference between TORS and open surgery in overall survival for supraglottic patients. This study suggests that TORS may be a viable treatment option for early-stage laryngeal cancer.Level Of Evidence: 4 Laryngoscope, 130:1195-1201, 2020. [ABSTRACT FROM AUTHOR]

Objective: To characterize industry research payments to otolaryngologists.Study Design: Cross-sectional retrospective analysis.Methods: We examined research payments made to otolaryngologists 2014 through 2017 included in the Open Payments Database. Trends in payment values over time were characterized and compared to other surgical specialties. Geographical and temporal trends in payments to specific principal investigators, along with the ties to specific companies, were analyzed.Results: Among surgical specialties, otolaryngology was the second lowest paid in terms of total compensation from industry for research per active U.S. physician. The median (mean) payment to otolaryngologists was $819 ($5,514), $548 ($3,083), $771 ($3,484), and $1,000 ($5,768) in 2014, 2015, 2016, and 2017, respectively. There was typically a higher mean and median payment per otolaryngologists in the Northeast, although significant differences between each region varied by year. The 40 most highly funded recipients had total compensation that was on average spread over 3.35 years of the database, 2.975 different companies, and 7.35 distinct scientific studies-all significantly higher compared to otolaryngologists with less funding.Conclusion: Research payments to otolaryngologists are concentrated in a small number of otolaryngologists; however, many of the most highly funded principal investigators worked on numerous studies with a variety of different companies over many years. Our characterization of the Open Payments Database over 4 years illustrates the depth of relationship between otolaryngology research and industry as well as raises awareness regarding the ease of connecting otolaryngologists to research payments.Level Of Evidence: NA Laryngoscope, 130:314-320, 2020. [ABSTRACT FROM AUTHOR]