{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T01:40:46Z","timestamp":1780450846881,"version":"3.54.1"},"reference-count":22,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T00:00:00Z","timestamp":1666569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor, and its prognosis is determined by the histological progression beyond the adenoma capsule. However, a preoperative evaluation of the histological progression remains challenging, and there is no consensus regarding treatment strategies for CXPA. Herein, we aimed to predict the histological progression preoperatively and develop an appropriate treatment strategy for CXPA. We retrospectively reviewed 22 patients with parotid gland CXPA recorded at our hospital. The clinicopathological characteristics were assessed, and survival analysis was performed. T3\u2264 or N+ were common in widely invasive CXPA (WICXPA) (p &lt; 0.05). A tumor diameter &gt; 40 mm and the N+ status were associated with poor prognosis considering overall survival (OS) and locoregional recurrence rate (LRC) (p &lt; 0.05). Patients with facial nerve paralysis exhibited better OS and LRC than those without facial nerve paralysis. More than 90% of patients with WICXPA experienced distant metastases. Meanwhile, there were no cases of recurrence or death due to intracapsular and minimally invasive CXPA. A preoperative advanced T stage or N+ status was suspected as WICXPA. Tumors &gt; 40 mm in size and N+ status necessitate high-intensity local treatment. Facial nerve invasion can be controlled by nerve resection. Postoperative systemic therapy could control distant metastases.<\/jats:p>","DOI":"10.3390\/life12111685","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T06:37:45Z","timestamp":1666593465000},"page":"1685","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Noteworthy Factors to Decide Therapeutic Strategy for Carcinoma ex Pleomorphic Adenoma of Parotid Gland: A Preliminary Study Statistical Analysis of 22 Cases from Single Institution"],"prefix":"10.3390","volume":"12","author":[{"given":"Kosei","family":"Mori","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670,  Japan"},{"name":"Department of Head and Neck Surgery, Chiba Cancer Center, Chiba 260-8717, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Yamasaki","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670,  Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Morimoto","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Chiba Cancer Center, Chiba 260-8717, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Chiba Cancer Center, Chiba 260-8717, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Asai","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670,  Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670,  Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9940-5520","authenticated-orcid":false,"given":"Tomohisa","family":"Iinuma","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670,  Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syuji","family":"Yonekura","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670,  Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9721-5662","authenticated-orcid":false,"given":"Toyoyuki","family":"Hanazawa","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670,  Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,24]]},"reference":[{"key":"ref_1","unstructured":"Barnes, L., and Eveson, J.W. (2005). Carcinoma expleomorphic adenoma. World Health Organization Classification on Tumors. Pathology and Genetics of Head and Neck Tumors, IARC Press."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/S0194-5998(99)70323-2","article-title":"Incidence rates of salivary gland tumors: Results from a population-based study","volume":"120","author":"Pinkston","year":"1999","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1038\/sj.bjc.6605953","article-title":"Quantitative promoter methylation differentiates carcinoma ex pleomorphic adenoma from pleomorphic salivary adenoma","volume":"103","author":"Schache","year":"2010","journal-title":"Br. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"426","DOI":"10.3109\/00016487409124645","article-title":"Malignancy in pleomorphic adenoma. A clinical and microspectrophotometric study","volume":"77","author":"Eneroth","year":"1974","journal-title":"Acta Otolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1002\/hed.26489","article-title":"Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma","volume":"43","author":"Yin","year":"2021","journal-title":"Head Neck"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1002\/1097-0142(197702)39:2<388::AID-CNCR2820390204>3.0.CO;2-D","article-title":"Malignant mixed tumor of salivary origin: A clinicopathologic study of 146 cases","volume":"39","author":"Spiro","year":"1977","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1053\/hupa.2001.25000","article-title":"Carcinoma ex pleomorphic adenoma: Pathologic analysis of 73 cases","volume":"32","author":"Lewis","year":"2001","journal-title":"Hum. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1111\/j.1365-2559.2005.02157.x","article-title":"Carcinoma ex pleomorphic adenoma (CXPA): Immunoprofile of the cells involved in carcinomatous progression","volume":"46","author":"Altemani","year":"2005","journal-title":"Histopathology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2559.2007.02719.x","article-title":"Advances in salivary gland pathology","volume":"51","author":"Cheuk","year":"2007","journal-title":"Histopathology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s12105-017-0795-0","article-title":"Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Salivary Gland","volume":"11","author":"Seethala","year":"2017","journal-title":"Head Neck Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1200\/JCO.18.00545","article-title":"Phase II trial of trastuzumab and docetaxel in patients with human epidermal growth factor receptor 2-positive salivary duct carcinoma","volume":"37","author":"Takahashi","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102279","DOI":"10.1016\/j.amjoto.2019.102279","article-title":"Carcinoma ex pleomorphic adenoma: A review of incidence, demographics, risk factors, and survival","volume":"40","author":"Gupta","year":"2019","journal-title":"Am. J. Otolaryngol."},{"key":"ref_13","first-page":"1324","article-title":"Predictors of survival in carcinoma ex pleomorphic adenoma","volume":"36","author":"Chen","year":"2014","journal-title":"Head Neck"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1245\/s10434-015-5082-2","article-title":"Clinical outcomes and prognostic factors for salivary duct carcinoma: A multi-institutional analysis of 141 patients","volume":"23","author":"Otsuka","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1002\/jso.23914","article-title":"Patterns and treatment of neck metastases in patients with salivary gland cancers","volume":"111","author":"Yoo","year":"2015","journal-title":"J. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.ijrobp.2007.01.009","article-title":"Prognostic factors depicting disease-specific survival in parotid-gland tumors","volume":"68","author":"Koul","year":"2007","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1016\/j.joms.2020.06.013","article-title":"Clinicopathologic features and prognostic factors of widely invasive carcinoma ex pleomorphic adenoma of parotid gland: A clinicopathologic analysis of 126 cases in a Chinese population","volume":"78","author":"Hu","year":"2020","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2526","DOI":"10.1002\/cncr.21116","article-title":"Clinical and immunohistologic typing of salivary duct carcinoma: A report of 50 cases","volume":"103","author":"Jaehne","year":"2005","journal-title":"Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/S0194-59980301386-X","article-title":"Salivary duct carcinoma","volume":"129","author":"Hosal","year":"2003","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"59023","DOI":"10.18632\/oncotarget.19812","article-title":"Biomarker immunoprofile in salivary duct carcinomas: Clinicopathological and prognostic implications with evaluation of the revised classification","volume":"8","author":"Takase","year":"2017","journal-title":"Oncotarget"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s10147-014-0674-6","article-title":"Clinicopathological significance of androgen receptor, HER2, Ki-67 and EGFR expressions in salivary duct carcinoma","volume":"20","author":"Masubuchi","year":"2015","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1093\/annonc\/mdx771","article-title":"A prospective phase II study of combined androgen blockade in patients with androgen receptor-positive metastatic or locally advanced unresectable salivary gland carcinoma","volume":"29","author":"Fushimi","year":"2018","journal-title":"Ann. Oncol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/11\/1685\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:01:34Z","timestamp":1760144494000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/11\/1685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,24]]},"references-count":22,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["life12111685"],"URL":"https:\/\/doi.org\/10.3390\/life12111685","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,24]]}}}