Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer

Abstract Objective To compare surgical and nonsurgical definitive treatment in cT4b major salivary gland cancer (MSGC). Study Design Retrospective cohort study. Setting The 2004 to 2019 National Cancer Database. Methods The NCDB was queried for patients with cT4b MSGC (N = 976). Patients undergoing definitive treatment with (1) surgical resection + adjuvant therapy, (2) radiotherapy (RT) alone, or (3) chemoradiotherapy (CRT) were included in Kaplan‐Meier and Cox survival analyses. Results Of 219 patients undergoing definitive treatment, 148 (67.6%) underwent surgical resection + adjuvant therapy and 71 (32.4%) underwent RT or CRT. There were no documented mortalities within 90 days of surgical resection. Tumor diameter and nodal metastasis were associated with decreased odds of undergoing definitive treatment ( P < 0.025). Patients with positive surgical margins (PSM) had higher 5‐year overall survival (OS) than those undergoing definitive RT or CRT (48.5% vs 30.1%, P = 0.018) and similar 5‐year OS as those with negative margins (48.5% vs 54.0%, P = 0.205). Surgical resection + adjuvant therapy (adjusted hazard ratio: 0.55, 95% confidence interval CI: 0.37‐0.84) was associated with higher OS than definitive RT or CRT ( P < 0.025). A separate cohort of 961 patients with cT4a tumors undergoing surgical resection + adjuvant therapy was created; cT4a and cT4b (hazard ratio: 1.02, 95% CI: 0.80‐1.29, P = 0.896) tumors had similar OS. Conclusion A minority of patients with cT4b MSGC undergo definitive treatment. Surgical resection + adjuvant therapy was safe and associated with higher OS than definitive RT or CRT, despite high rate of PSM. In the absence of clinical trial data, appropriately selected patients with cT4b MSGC may benefit from surgical resection.