{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:41:39Z","timestamp":1791477699195,"version":"4.3.4"},"reference-count":80,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare surgical and nonsurgical definitive treatment in cT4b major salivary gland cancer (MSGC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The 2004 to 2019 National Cancer Database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The NCDB was queried for patients with cT4b MSGC (N\u2009=\u2009976). Patients undergoing definitive treatment with (1) surgical resection\u2009+\u2009adjuvant therapy, (2) radiotherapy (RT) alone, or (3) chemoradiotherapy (CRT) were included in Kaplan\u2010Meier and Cox survival analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 219 patients undergoing definitive treatment, 148 (67.6%) underwent surgical resection\u2009+\u2009adjuvant 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 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.025). Patients with positive surgical margins (PSM) had higher 5\u2010year overall survival (OS) than those undergoing definitive RT or CRT (48.5% vs\u00a030.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.018) and similar 5\u2010year OS as those with negative margins (48.5% vs\u00a054.0%, <jats:italic>P<\/jats:italic>\u2009=\u20090.205). Surgical resection\u2009+\u2009adjuvant therapy (adjusted hazard ratio: 0.55, 95% confidence interval [CI]: 0.37\u20100.84) was associated with higher OS than definitive RT or CRT (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.025). A separate cohort of 961 patients with cT4a tumors undergoing surgical resection\u2009+\u2009adjuvant therapy was created; cT4a and cT4b (hazard ratio: 1.02, 95% CI: 0.80\u20101.29, <jats:italic>P<\/jats:italic>\u2009=\u20090.896) tumors had similar OS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A minority of patients with cT4b MSGC undergo definitive treatment. Surgical resection\u2009+\u2009adjuvant 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.686","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T07:24:24Z","timestamp":1709277864000},"page":"1349-1363","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer"],"prefix":"10.1002","volume":"170","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0794-041X","authenticated-orcid":false,"given":"Aman M.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afash","family":"Haleem","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassaam S.","family":"Choudhry","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Brant","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Brody","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Corporal Michael J. 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