MINOR SALIVARY-GLAND TUMORS OF THE PALATE - CLINICAL AND PATHOLOGICALCORRELATES OF OUTCOME

Minor salivary gland tumors of the palate are rare and may pose a diag nostic and therapeutic dilemma for the head and neck surgeon. The auth ors reviewed their 46 years of experience with minor salivary gland tu mors of the palate to determine the factors that influence outcome and their implications for treatment. Malignant tumors were seen in 116 p atients (78%) and benign tumors were found in 33 patients (22%). Adeno id cystic carcinoma was the most common malignant tumor, occurring in 43 patients, and pleomorphic adenoma was the most common benign tumor, occurring in 30 patients. Univariate analysis on the malignant lesion s showed that grade 3 tumor histology (P<.001), tumor size greater tha n 3 cm (P<.001), perineural invasion (P=.031), bone invasion (P=.012), positive surgical margins (P<.001), and positive initial but negative final margins (P=.004) were all associated with decreased survival. W ith multivariate analysis, tumor size, margin status, and grade were s hown to be independently associated with decreased survival (P<.05). T he recurrence rate at the primary site was significantly higher for ad enoid cystic carcinoma than for other histologies (P=.0059). The 2-, 5 -, and 10-year disease-specific survival rates for patients with malig nant disease were 96%, 87%, and 80%, respectively. Wide surgical excis ion with adequate margins is essential for a favorable outcome in pati ents with malignant minor salivary gland tumors. Postoperative radioth erapy is reserved for patients with grade 3 tumor histology, large pri mary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins, although a clear-cut survival advant age has not been proven. Recurrence, especially regional and distant m etastasis, portends an extremely poor prognosis.