Surgery vs chemoradiation therapy for locally advanced parotid gland squamous cell carcinoma: a population-based propensity score matched study.

Background

Parotid gland squamous cell carcinoma (PSCC) is a rare malignancy with limited evidence regarding optimal management strategies. AIMS/

Objectives

To compare survival outcomes between surgery and definitive chemoradiation therapy (CRT) in patients with locally advanced PSCC.

Materials And Methods

Data on 1,320 patients with T3/T4a M0 PSCC treated with surgery or CRT were retrieved from a population-based database. Inverse probability of treatment weighting (IPTW) was applied to adjust for selection biases. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using the Kaplan-Meier method and Cox proportional hazards models.

Results

After IPTW adjustment, the surgery group achieved significantly superior 5-year OS (38.9% vs. 27.7%, p = 0.027) and 5-year CSS (61.2% vs. 43.8%, p = 0.003) compared with the CRT group. In multivariate analyses, CRT was an independent adverse prognostic factor for OS (HR 1.50, 95% confidence interval (CI) 1.12-2.01) and CSS (HR 1.76, 95%CI 1.21-2.55). In surgical patients, postoperative radiotherapy or CRT significantly improved survival over surgery alone.

Conclusions

AND

Significance

Surgery followed by adjuvant therapy provides superior survival outcomes and remains the preferred strategy for resectable advanced PSCC. Definitive CRT yields inferior survival rates but may be considered for organ preservation.