Prognosis and predictive factors

Factors that influence survival include histologic patterns, tumour site, clinical stage, bone involvement and status of surgical margins {1849,2016,2439,2444, 2519}. Generally, tumours composed of tubular and cribriform patterns pursue a less aggressive course than those with greater than 30% of solid component {2519}. Along with the histologic pattern, clinical stage greatly affects prognosis.

Other studies have failed to confirm the value of grading {2439,2444} and underscored the significance of tumour size and clinical stage as the most consistent predictors of clinical outcome in patients with these tumours {2442,2449}. The 5-year survival rate is approximately 35% but the long-term survival is poorer. Eighty to 90% of patients die of disease in 10-15 years {993,2016}. The local recurrence rate ranges from 16-85% in several series of these tumours. Recurrence is a serious sign of incurability. Lymph node involvement is uncommon but has been reported to range from 5-25% and typically from tumours of the submandibular gland and is often due to contiguous spread rather than metastasis. The incidence of distant metastasis is estimated to range from 25-55%. The lung followed by bone, brain and liver are the common sites. Only 20% of patients with distant metastasis survive 5-years. The influence of perineural invasion on survival has been contradictory {860}. Wide local and radical surgical excisions with and without post-operative radiation is the treatment of choice {54,339, 1849,2439,2444,2519}. Radiation alone or with chemotherapy in the treatment of recurrent or metastatic disease has shown limited success. Radiotherapy, however, has been shown to improve local control in cases with microscopic residual disease {2670}. The value of chemotherapy in these tumours is limited and remains to be proven.

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