{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:53:40Z","timestamp":1786978420568,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T00:00:00Z","timestamp":1674086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The role and extent of neck dissection in primary parotid cancer are controversial. Herein, we characterize patterns of lymph node metastasis in parotid cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>National Cancer Database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with the 6 most common histologic subtypes of parotid cancer were selected. Primary outcomes were the distribution of positive lymph nodes by level and overall survival assessed by Cox analysis. Secondary outcomes included predictors of extended lymph node involvement (\u22653 lymph nodes or Level IV\/V involvement), via logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six thousand nine hundred seventy\u2010seven\u00a0patients with acinic cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma (CExPA), mucoepidermoid carcinoma, and salivary duct carcinoma (SDC) were included. Among cN0 patients, 8.2% of low\u2010grade tumor patients had occult nodal metastasis versus 30.9% in high\u2010grade tumor patients. Elective neck dissection was not associated with an overall survival benefit (adjusted hazard ratio: 1.10; 0.94\u20101.30,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.238). Among cN+ tumors, CExPA (odds ratio [OR]: 1.88, 1.05\u20103.39,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.034) and high\u2010grade pathology (OR: 3.03, 1.87\u20104.93,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001) were predictive of having \u22653 pathologic nodes. CExPA (OR: 2.13, 1.22\u20103.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.008), adenocarcinoma (OR: 1.60, 1.11\u20102.31,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.013), SDC (OR: 1.92, 1.17\u20103.14,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01), and high\u2010grade pathology (OR: 3.61, 2.19\u20105.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001) were predictive of Level IV\/V neck involvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In parotid malignancy, nodal metastasis distribution is dependent on histology and grade. High\u2010grade tumors and certain histologies (SDC and adenocarcinoma) had a higher incidence of occult nodes. Comprehensive neck dissection should also be considered for node\u2010positive high\u2010grade tumors, SDC, and adenocarcinoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.167","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T04:49:35Z","timestamp":1674103775000},"page":"1067-1078","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Patterns of Lymph Node Metastasis in Parotid Cancer and Implications for Extent of Neck Dissection"],"prefix":"10.1002","volume":"168","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-844X","authenticated-orcid":false,"given":"Rohith S.","family":"Voora","sequence":"first","affiliation":[{"name":"University of California San Diego School of Medicine  La Jolla California USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of California San Diego School of Medicine  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1149-9532","authenticated-orcid":false,"given":"Bharat","family":"Panuganti","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of California San Diego School of Medicine  La Jolla California USA"},{"name":"Gleiberman Head and Neck Cancer Center Moores Cancer Center  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4715-6761","authenticated-orcid":false,"given":"Joseph","family":"Califano","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of California San Diego School of Medicine  La Jolla California USA"},{"name":"Gleiberman Head and Neck Cancer Center Moores Cancer Center  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4513-3400","authenticated-orcid":false,"given":"Charles","family":"Coffey","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of California San Diego School of Medicine  La Jolla California USA"},{"name":"Gleiberman Head and Neck Cancer Center Moores Cancer Center  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of California San Diego School of Medicine  La Jolla California USA"},{"name":"Gleiberman Head and Neck Cancer Center Moores Cancer Center  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556131709600319"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1586\/era.12.92"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23914"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3681-y"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2004.09.029"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19920201)69:3<615::AID-CNCR2820690303>3.0.CO;2-9"},{"key":"e_1_2_8_8_1","volume-title":"NCCN Clinical Practice Guidelines in Oncology. 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