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Biomedical subjects

Neil Bhattacharyya

Publications and source records attributed to Neil Bhattacharyya.

At least 55 records · Page 3Linked to original sources
PubMed2003

Improved outcomes with early vocal fold medialization for vocal fold paralysis after thoracic surgery.

OBJECTIVE: To determine the clinical impact of early versus late surgical therapy for new onset unilateral vocal cord paralysis (UVCP) after thoracic surgery. STUDY DESIGN: Patients diagnosed with new onset UVCP after esophagectomy, pneumonectomy or pulmonary lobectomy were reviewed to determine the incidence of pneumonia, need for postoperative bronchoscopy and length of stay (LOS). Comparisons were made between patients undergoing early (< or = 4 days after thoracic procedure) versus late rehabilitation (> or = 5 days after thoracic procedure) of their UVCP with vocal cord medialization. RESULTS: Some 86 patients (27 esophagectomies, 43 pneumonectomies and 16 lobectomies) with new onset UVCP were examined. A total of 32 patients (37.2%) underwent early vocal cord medialization and 54 (62.8%) underwent late repair. The pneumonia rate for patients undergoing early vocal cord medialization (6.3%) was significantly lower than the rate for vocal cord medialization (37.0%, P=0.001, chi(2)). Early medialization patients required fewer postoperative bronchoscopies (mean number of bronchoscopies, 0.26) than late medialization patients (mean bronchoscopies, 0.94, P=0.013). The median LOS was significantly decreased for early versus late medialization patients in both pneumonectomy (reduction in LOS of 8 days) and lobectomy groups (reduction in LOS of 7 days). CONCLUSIONS: Early vocal cord medialization decreases the pneumonia rate, the requirement for postoperative bronchoscopies and the LOS for patients suffering from new onset UVCP after thoracic surgery. SIGNIFICANCE: Consideration should be given to early medialization for new onset UVCP when medically sound.

Bronchoscopy↗
PubMed2003

A population-based analysis of survival factors in differentiated and medullary thyroid carcinoma.

OBJECTIVE: The study purpose was to determine survival and prognostic factors for differentiated thyroid carcinoma (DTC). METHODS: Cases of DTC were extracted from the Surveillance, Epidemiology and End Results database from 1988 through 1998. Kaplan-Meier survival analysis was conducted for papillary, follicular, and medullary histologies. Cox proportional hazard analysis was used to examine the influence of age, gender, tumor size, local extension, and cervical node involvement on overall survival. RESULTS: A total of 18,118 cases were identified, including 15,820 (87.3%) papillary carcinomas, 1799 (9.9%) follicular carcinomas, and 499 (2.8%) medullary carcinomas. Mean survival (10-year survival) was 122 (87.7%), 117 (80.2%), and 108 (73.7%) months for papillary, follicular, and medullary tumors, respectively. For each histology, increasing age, male gender, and degree of local extension substantially reduced survival. Cervical metastasis did not influence survival for papillary or follicular carcinomas but approached significance for medullary carcinoma (P = 0.065). CONCLUSIONS: Degree of local extension in thyroid carcinoma should be subclassified to more accurately determine prognosis. Treatment of the neck should be considered for medullary thyroid carcinoma.

Adenocarcinoma, Follicular↗
PubMed2003

The accuracy of computed tomography in the diagnosis of chronic rhinosinusitis.

OBJECTIVE: To determine the sensitivity, specificity, and diagnostic accuracy of paranasal sinus computed tomography (CT) in the diagnosis of chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective dual cohort study. METHODS: One hundred seventy-one consecutive patients undergoing endoscopic sinus surgery for CRS were evaluated with CT and staged according to the Lund system. Histopathological findings from sinus specimens were reviewed and graded. A second contemporaneous control group of 130 patients undergoing CT of the sinus regions for other reasons but without a diagnosis of CRS was also staged. Sensitivity, specificity, and the receiver-operator characteristic were determined for the sinus CT in the diagnosis of CRS. Positive and negative predictive values were also computed. RESULTS: In the disease-positive group of patients with CRS, the mean Lund score was 9.8 (95% confidence interval, 9.0-10.6). The mean inflammatory grade on histopathological study was 2.3 (range, 0-4). For the control group (without disease), the mean Lund score was 4.3 (95% confidence interval, 3.5-5.0). The AUC for the receiver-operator characteristic was 0.802 (P <.001). Selecting a Lund score cut-off value of greater than 2 as abnormal, the sinus CT exhibited sensitivity and specificity of 94% and 41%, respectively. Increasing the cut-off value to 4 changed the sensitivity and specificity to 85% and 59%, respectively. CONCLUSIONS: The paranasal sinus CT scan exhibits good sensitivity and above-average specificity for the diagnosis of CRS. When added to the history and physical findings, CT may add to the diagnostic accuracy of CRS.

Adult↗
PubMed2003

A matched survival analysis for squamous cell carcinoma of the head and neck in the elderly.

OBJECTIVE: To determine whether elderly patients manifest poorer survivals for head and neck squamous cell carcinoma. METHODS: Cases of squamous cell carcinoma of the glottic larynx, oral tongue, and tonsil were extracted from the Surveillance, Epidemiology and End Results database for 1988 to 1998. For each primary site, patients were segregated into two age groups: 50 to 69 years of age and 70 years of age and older. For each case in the latter, elderly group, a reference group case was randomly matched for gender, year of diagnosis, cancer stage, extent of surgery, and radiation therapy. Overall survival and disease-specific survival were compared between the two groups with stage stratification with the Kaplan-Meier method. RESULTS: Cases of glottic carcinoma (1882), tongue carcinoma (426), and tonsillar carcinoma (200) in elderly patients were matched to the reference group. Overall mean survival differences were significant for glottic carcinoma (73.9 vs. 96.7 mo, elderly and younger groups, respectively) (P <.001) and tongue carcinoma (59.5 vs. 73.1 mo) ( P=.002) but not for tonsillar carcinoma (46.0 vs. 54.4 mo) ( P=.220). Disease-specific survival differences were significant but small in magnitude for glottic carcinoma (105.9 vs. 114.1 mo, respectively (P <.001) and tongue carcinoma (81.6 vs. 93.6 mo) (P =.009) but not for tonsillar carcinoma (71.5 vs. 70.7 mo) (P =.422). However, after stage stratification, elderly patients often did not exhibit statistically or practically significant poorer overall or disease-specific survivals. CONCLUSIONS: Elderly patients do not necessarily exhibit clinically significant poorer survivals for head and neck squamous cell carcinoma. Age alone should not be used to determine treatment options for elderly patients with squamous cell carcinoma.

Age Factors↗
PubMed2002

Assessment of the morbidity and complications of total thyroidectomy.

OBJECTIVE: To determine the incidence and predictive factors for complications after total thyroidectomy. DESIGN: Cross-sectional analysis of a national database on total thyroidectomy cases. METHODS: The National Hospital Data Survey database was examined and all cases of total thyroidectomy performed during 1995 to 1999 were extracted. In addition to demographic information, postoperative complications including hypocalcemia, recurrent laryngeal nerve paralysis, wound complications, and medical morbidities were identified. Statistical analysis was conducted to determine potential predictive factors for postoperative complications. RESULTS: A total of 517 patients were identified (mean age, 48.3 years). The most common indications for total thyroidectomy were thyroid malignancy and goiter (73.9% of cases). Eighty-one patients (15.7%) underwent an associated nodal dissection along with total thyroidectomy, and 16 patients (3.1%) underwent parathyroid reimplantation. The mean length of stay was 2.5 days (95% confidence interval, 2.3-2.8 days). The incidence of postoperative wound hematoma was 1.0%, wound infection was 0.2%, and mortality rate was 0.2%. The incidence of postoperative hypocalcemia was 6.2%. Younger age was statistically associated with an increased incidence of hypocalcemia (P =.002, t test), whereas sex (P =.48), indication for surgery (P =.32), parathyroid reimplantation (P>.99), and associated neck dissection (P =.21) were not. The mean length of stay was 2.5 days and was unaffected by occurrence of postoperative hypocalcemia. The incidences of unilateral and bilateral vocal cord paralyses were 0.77% and 0.39%, respectively. CONCLUSIONS: Postoperative hypocalcemia is the most common immediate surgical complication of total thyroidectomy. Other complications, including recurrent laryngeal nerve paralysis, can be expected at rates approximating 1%.

Cross-Sectional Studies↗
PubMed2002

Nodal metastasis in major salivary gland cancer: predictive factors and effects on survival.

OBJECTIVES: To determine how regional nodal metastasis affects survival in patients with major salivary gland malignancy and to identify clinical predictors for nodal disease. METHODS: Major salivary gland cancer cases with nodal sampling were identified from the Surveillance, Epidemiology, and End Results cancer database for 1988 through 1998. Kaplan-Meier survival analysis was conducted to compare patients with and without histopathologic evidence of nodal disease. Multivariate logistic regression analysis was used to determine the influence of clinical predictors on the presence of regional nodal disease. RESULTS: A total of 1268 patients with major salivary gland malignancy and regional node sampling were identified. Mean age at diagnosis was 58.3 years, with a male-female ratio of 1:4. Mean tumor size was 3.0 cm. Overall mean survival time was 83 months (95% confidence interval, 80-87 months). Patients with no evidence of nodal cancer had significantly improved survival over patients with any pathologically positive nodes (mean survival time, 100 months vs 59 months, respectively; P<.001). Patient age, tumor histopathologic type, facial nerve involvement, extraglandular involvement, tumor grade, and tumor size were significant clinical predictors of nodal disease. Facial nerve involvement, tumor grade, and squamous cell carcinoma subtype exhibited the highest increased odds ratios for nodal metastasis. CONCLUSIONS: Nodal disease significantly decreases survival in patients with major salivary gland malignancy. Tumor histopathologic type, facial nerve involvement, extraglandular tumor extension, and tumor grade are the most important predictors of nodal disease.

Adult↗
PubMed2002

Cancer of the nasal cavity: survival and factors influencing prognosis.

OBJECTIVE: To determine overall survival and prognostic factors for cancer of the nasal cavity. DESIGN: Cross-sectional analysis of a national cancer database. METHODS: All cases of nasal cavity cancer were extracted from the Surveillance, Epidemiology and End Results database for 1988 through 1998. Cases with distant metastatic disease were excluded. Tumor histologic types, TNM staging, and pathological features were computed. Kaplan-Meier and Cox proportional hazards analyses were conducted to determine factors influencing overall survival. RESULTS: A total of 981 cases were identified, with 3.5% presenting with distant metastatic disease. After exclusion of missing variables, 783 cases were analyzed, with a mean patient age of 63.8 years. Squamous cell carcinoma was the most common tumor histologic type (49.3%), followed by esthesioneuroblastoma (13.2%). More than half of the cases presented with early (T1) primary site disease, and only 5% had positive nodal disease at presentation. Overall mean (median) survival was 76 (81) months, with an overall 5-year survival rate of 56.7%. On multivariate analysis, male sex, increasing age, T stage, N stage, and poorer tumor grade independently adversely affected survival (P<.05). Radiotherapy was administered in 50.5% of patients and also independently predicted poorer survival (P =.03). The mean (median) survival for squamous cell carcinoma was 79 (84) months; only melanoma showed a statistically significantly poorer mean survival of 40 (30) months when compared with other tumors (P<.001). CONCLUSIONS: Age, sex, and staging variables have a significant prognostic impact in nasal cavity cancer. Melanomas of the nasal cavity manifest very poor survival.

Age Factors↗
PubMed2002

The role of infection in chronic rhinosinusitis.

Chronic rhinosinusitis is a common condition, yet little is understood about its pathogenesis. Chronic infection traditionally has been considered a significant factor in the etiology and manifestations of chronic rhinosinusitis. Bacteria can be recovered in most cases of chronic rhinosinusitis, most commonly consisting of Staphylococcus species, anaerobes, and in some cases, gram-negative bacteria. Increasing trends toward bacterial resistance have been identified in chronic rhinosinusitis. Recently, a potential role for fungal infection has emerged. A knowledge of the microbiology of chronic rhinosinusitis will help guide treatment, but more research is required to understand further the exact role of infection in the pathophysiology of chronic rhinosinusitis.

Bacterial Infections↗
PubMed2002

Contemporary trends in microbiology and antibiotic resistance in otolaryngology.

OBJECTIVE: to determine current microbiologic yields and characterize antibiotic resistance patterns for organisms cultured from head and neck infections. METHODS: results of out-patient cultures submitted from an academic otolaryngology practice over the period 1994-1998 were reviewed. A database was constructed, and culture results were analyzed for sites of infection, organism recovery rate, infecting microbiological agent, antibiotic resistance patterns, and 5-year trends. chi(2) analysis was used to determine associations between site of infection, infecting agent and antibiotic resistance over the years of the study. RESULTS: a total of 986 aerobic cultures were reviewed. The most common sites cultured were the nose/paranasal sinuses (469), throat (377), and ear (23). In 465 (47.2%) cultures, normal flora or no growth occurred. Of the throat culture subset, 69.7% were negative, whereas 69.1% of sinonasal cultures recovered organisms. Gram positive cocci were the most commonly recovered organism type (30.9%), followed by Gram negative rods (GNR, 17.2%). These rates remained relatively constant over the years of the study. GNR were found in 39.1 and 25.2% of ear and sinus cultures, respectively. Antibiotic sensitivities were conducted on 257 specimens (49.3% of positive cultures). The average number of antibiotic resistances per bacteria remained stable at approximately 1.59 over the years (P=0.086, analysis of variance (ANOVA)). Antibiotic resistance rates increased for clindamycin, cefazolin, and erythromycin over the years of the study (P<0.05, chi(2)). Ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole resistance rates did not increase over the years of the study. Vancomycin resistance did not occur. CONCLUSIONS: as a significant proportion of head and neck cultures will be negative, their utility should be re-examined. GNR infections are more common in the head and neck than earlier thought. There is a trend towards increasing antibiotic resistance in head and neck infections, urging careful and appropriate use of antibiotics.

Adolescent↗
PubMed2002

The reliability of the assessment of endoscopic laryngeal findings associated with laryngopharyngeal reflux disease.

OBJECTIVE: To determine the reliability of the assessment of laryngoscopic findings potentially associated with laryngopharyngeal reflux disease (LPRD). STUDY DESIGN: Prospective randomized blinded study. METHODS: One hundred twenty video segments of rigid fiberoptic laryngeal examinations were prospectively analyzed by five otolaryngologists blinded to patient information and were scored according to several variables potentially associated with LPRD. Separate assessments of the degree of erythema and degree of edema were scored on a five-point scale for the anterior commissure, membranous vocal fold, and interarytenoid region. Similarly, interarytenoid pachydermia, likelihood of LPRD involvement, and severity of LPRD findings were assessed. For each of these scored physical findings, inter-rater and intrarater reliabilities were determined. RESULTS: The inter-rater reliabilities of the laryngoscopic findings associated with LPRD were poor. Intraclass correlation coefficients were 0.161 and 0.461 for edema of the arytenoids and membranous vocal folds, respectively (P <.001). Intraclass correlation coefficients were 0.181 and 0.369 for erythema of the arytenoids and membranous vocal folds, respectively (P <.001). Raters demonstrated poor agreement as to the severity of LPRD findings (intraclass correlation coefficient, 0.265) and the likelihood of an LPRD component for dysphonia (intraclass correlation coefficient, 0.248). Similarly, intrarater reliability was extremely variable for the various physical findings, with Kendall correlation coefficients ranging from -0.121 to 0.837. CONCLUSIONS: Accurate clinical assessment of laryngeal involvement with LPRD is likely to be difficult because laryngeal physical findings cannot be reliably determined from clinician to clinician. Such variability makes the precise laryngoscopic diagnosis of LPRD highly subjective.

Edema↗
PubMed2002

Patterns of swallowing failure following medialization in unilateral vocal fold immobility.

OBJECTIVE: To quantify the incidence of penetration and aspiration following medialization for unilateral vocal cord immobility (UVCI) and determine patterns of failure. STUDY DESIGN: Blinded analysis consecutive case series. METHODS: Prospective blinded analysis of videofluoroscopic swallowing studies of patients who had received a medialization procedure was conducted, determining the incidence of penetration and aspiration by using the Penetration-Aspiration Scale. Pharyngeal transport measures were also assessed. Associations between clinical factors and penetration-aspiration were statistically determined. RESULTS: Sixty-seven videofluoroscopic swallowing studies were reviewed in patients (mean age, 63.3 y) who had undergone vocal fold medialization (14 laryngoplasties and 53 vocal cord injections) for UVCI. Unilateral vocal cord immobility was left-sided in 56 patients (83.6%), and 50 patients (74.6%) had a postsurgical etiologic factor for their immobility. Thirty (44.8%) and 16 (23.9%) patients demonstrated penetration and aspiration, respectively. Penetration most often occurred during the swallow, but aspiration was equally likely to occur during or after the swallow. No differences in the incidence of penetration or aspiration were noted according to the side of vocal fold paralysis ( P=.20, chi test) or etiologic factor ( P=.69). Further analysis found that swallow factors significantly associated with penetration and aspiration were swallow delay ( P=.001, Wilcoxon ranked pairs test) and reduced laryngeal elevation ( P=.001), as well as bolus residues in the valleculae (P =.002), piriform sinus ( P=.001), or posterior pharynx (P =.008). CONCLUSIONS: Many patients demonstrate significant radiographic aspiration even after medialization procedures for UVCI. Although glottal incompetence is a known risk factor for aspiration, other factors including pharyngeal bolus transport are important in determining an effective swallow in UVCI.

Barium Sulfate↗
PubMed2002

Dysphagia and aspiration with unilateral vocal cord immobility: incidence, characterization, and response to surgical treatment.

To objectively determine the incidence of dysphagia associated with unilateral vocal cord immobility (UVCI) and to evaluate the potential for response to vocal cord medialization, we made videofluoroscopic swallowing (VFS) recordings of patients with newly diagnosed UVCI and prospectively analyzed them in a blinded fashion using the Penetration-Aspiration Scale (PAS) and pharyngeal transport function measures. A subset of patients underwent vocal cord medialization and were evaluated with a postoperative VFS study. Comparison was made between preoperative and postoperative VFS results to study the effects of vocal cord medialization in this setting. Eighty-seven VFS recordings were studied in 64 adult patients with UVCI; 23 patients underwent VFS testing before and after vocal cord medialization. The UVCI was most commonly left-sided (53 cases) and most commonly resulted from thoracic or cardiac surgery (53.1%), followed by malignancy (15.6%). Overall, the median PAS score was 2.0 (25th-75th percentiles, 1.0-5.0), with 20 patients (31.3%) and 15 patients (23.4%) exhibiting penetration or aspiration, respectively. No significant differences in swallowing function were noted between surgical and nonsurgical causes of paralysis (PAS scores of 2.0 and 2.0, respectively; p = .901). The median PAS score improved from 4.0 to 3.0 (p = .395, Wilcoxon paired samples test) in patients studied after undergoing a vocal cord medialization procedure (6 laryngoplasties and 17 vocal cord injections). Laryngoplasty was not more successful than vocal cord injection in resolving aspiration (p = .27). Radiographically significant penetration or aspiration occurs in approximately one third of patients with UVCI, independent of the cause of paralysis. Vocal cord medialization may not be as effective as thought for eliminating aspiration in these patients.

Deglutition↗
PubMed2002

Economic benefit of tonsillectomy in adults with chronic tonsillitis.

To determine the economic impact of adult chronic tonsillitis and the economic improvement from adult tonsillectomy, we studied patients who underwent adult tonsillectomy for chronic tonsillitis with the Glasgow Benefit Inventory and a questionnaire for disease severity parameters before and after tonsillectomy. The economic impact of chronic tonsillitis and adult tonsillectomy were computed with a break-even time analysis model. Eighty-three adult patients (average age, 27.3 years) completed the study with an average duration of follow-up of 37.7 months. The patients exhibited a mean improvement in quality of life of +27.54 +/- 4.63 after tonsillectomy according to the Glasgow Benefit Inventory. In the 12 months following the procedure, tonsillectomy resulted in yearly mean decreases in number of weeks on antibiotics by 5.9 weeks, number of workdays missed because of tonsillitis by 8.7 days, and physician visits for tonsillitis by 5.3 visits. In considering the medical costs of tonsillectomy only, the break-even point was found to be 12.7 years, whereas considering the overall economic impact of tonsillectomy resulted in a break-even point of 2.3 years after the procedure. We conclude that tonsillectomy results in significant improvement in quality of life, decreases health-care utilization, and diminishes the economic burden of chronic tonsillitis in the adult patient population.

Adult↗
PubMed2002

Management pitfalls in the use of embolization for the treatment of severe epistaxis.

Angiographic embolization for the treatment of severe recurrent epistaxis was added to the traditional treatment options--nasal packing, cauterization, and surgical vessel ligation--in 1974. Since then, clinical experience has shown that this procedure is safe and effective. When epistaxis cannot be controlled with cautery, nasal packing is the most common next step. As such, it is often performed by emergency physicians and other clinicians who are not otolaryngologists. We report two cases in which intranasal neoplasms were obscured as a result of a significant distortion of the normal anatomy. This distortion was secondary to emergency-room treatment of severe epistaxis by repeated nasal packing followed by angiographic embolization. Pre-embolization angiographic studies and subsequent postembolization endoscopic evaluations did not reveal the presence of the occult neoplasms because of the presence of inflammation and edema after treatment. Clinicians should be aware that nasal packing and embolization can obscure the underlying source of epistaxis, and follow-up radiologic studies and endoscopic evaluations are essential to avoid delays in diagnosis.

Adult↗
PubMed2002

Microbiology of the ethmoid sinus following endoscopic sinus surgery.

We prospectively studied the native microbiology of the ethmoid sinus following endoscopic sinus surgery in 113 patients (mean age: 41.3 yr). After each patient had regained complete mucosalization (minimum follow-up: 6 wk), we obtained a bacterial swab of the ethmoid sinus and submitted it for culture and sensitivity analysis. We then compiled data on sensitivity patterns and the number and type of bacteria isolated. Of the 113 patients, 67 (59.3%) had positive cultures, 26 (23.0%) had sterile cultures, and 20 (17.7%) had normal flora. Multiple bacteria were isolated in 31 of the 113 patients (27.4%). The most common isolates were gram-positive cocci, and the most common bacteria were staphylococcal species. A significant degree (42.9%) of beta-lactamase resistance was exhibited. We conclude that the ethmoid sinus is not microbiologically sterile following endoscopic sinus surgery.

Adult↗
PubMedDate not supplied

The impact of race on survival in nasopharyngeal carcinoma: a matched analysis.

OBJECTIVE: To determine if nasopharyngeal carcinoma (NPC) exhibits significant prognostic differences in Chinese versus white patients. METHODS: From the Surveillance, Epidemiology, and End Results database for the time period 1988 to 2000, all cases of NPC were extracted and staging variables computed. To each case of NPC diagnosed in a Chinese patient, a case of NPC in a white patient was randomly matched for age at diagnosis, gender, grade, stage, and treatment modality. Kaplan-Meier survival analysis was then conducted for the matched groups comparing overall survival and disease-specific survival both for the overall matched cohort and stage stratified cohorts. RESULTS: Among 1,520 cases of NPC, 338 were identified in Chinese patients with staging information. Of these, 171 were successfully matched to white patients. Average age at presentation was 51.5 years with a 3:1 male predominance. Overall survival was substantially better for Chinese patients (mean survival, 94 months; median survival, 95 months) than for white patients (81 months and 64 months, P =.037). Stratified for stage, overall survival was better for Chinese patients for stage 3 but not stage 4 disease (P =.012 and P =.447, respectively). Disease-specific survival was not substantially different between Chinese patients (mean survival, 116 months) and white patients (mean survival 117 months, P =.99). No differences in disease-specific survival were identified for race when stratified by stage (all P >.05). CONCLUSIONS: Although overall survival is better for Chinese patients with NPC compared with white patients, disease-specific survival is similar between these racial groups. These data suggest that the biological behavior of NPC is relatively independent of race.

Asian People↗
PubMedDate not supplied

Determinants of survival in parotid gland carcinoma: a population-based study.

PURPOSE: To determine survival and factors influencing survival for parotid gland cancer. METHODS: Cases of parotid gland malignancy were extracted from the SEER database for 1988 to 1998. Kaplan-Meier survival analysis was conducted for the most common tumor histologies. Cox proportional hazards modeling was conducted to determine the influence of age, gender, histopathology, grade, size, regional modal status, extraglandular extension, and radiation therapy on survival. Subset analysis was conducted for mucoepidermoid carcinoma according to grade. RESULTS: Nine hundred three patients were identified with a mean age of 59.2 years. Mean follow-up was 51.8 months. Mean 5-year and 10-year actuarial survivals for the entire cohort were 87.8 months, 66.6% and 49.7%, respectively. Mean tumor size at diagnosis was 2.7 cm; 38.0% of patients had extraglandular extension of the tumor, 26.8% of patients had positive nodal disease, and 59.4% of patients received radiation therapy. Tumor histology did predict survival, with squamous cell carcinoma and acinar cell carcinoma exhibiting the poorest and best survivals, respectively. Stratified Cox proportional hazards modeling revealed that increasing age, tumor size, grade, extraglandular extension, and nodal positivity significantly negatively influenced survival (all P<or=.001); radiation therapy conferred a survival benefit (P=.090), whereas gender did not significantly affect survival. Increasing tumor grade, nodal disease, and extraglandular extension carried particularly high hazards ratios. CONCLUSIONS: Survival in parotid gland malignancy is influenced by multiple factors. Patients with multiple poor prognostic features such as extraglandular extension, aggressive tumor histologies, and nodal disease will exhibit poorer survivals and may be candidates for more aggressive treatment protocols.

Adenocarcinoma↗