Sex-based differences in malignant major salivary gland tumors: a nationwide population-based study from Israel

Purpose To evaluate sex-based differences in tumor characteristics, treatment patterns, and oncologic outcomes among patients with malignant major salivary gland tumors (MMSGTs). Methods A population-based retrospective cohort study was conducted using data from Clalit Health Services and the Israeli National Cancer Registry, including patients diagnosed with MMSGTs between 2002 and 2020. Sex-based differences in tumor characteristics, treatment, and outcomes were assessed. Overall survival (OS) and a composite oncologic outcome of recurrence or disease-specific mortality were analyzed. Results 336 patients were included, 53.6% were female with a mean age of 59.4 ± 18.7 years. Mucoepidermoid carcinoma (MEC) was the most frequent histologic subtype (34.2%). Female patients were younger ( p = 0.05), more often diagnosed with low-grade tumors ( p < 0.001), and more frequently presented with early-stage disease ( p < 0.001). Recurrence occurred in 19.3% of patients, and 20.2% died of the disease. In multivariable analysis, older age, high-grade tumors, and advanced T-stage were associated with worse OS, while male sex showed a borderline association (adjusted hazard ratio (HR) 1.44, p = 0.055). When outcomes were examined within histologic subgroups, female patients demonstrated better OS and composite oncologic outcome in MEC ( p = 0.004 and p = 0.012, respectively). Conclusions Female patients with MMSGTs demonstrated favorable clinicopathologic features at presentation and a trend toward improved OS compared with males. These differences appear largely attributable to younger age, lower tumor grade, and earlier stage at diagnosis among females.