Clinical, pathological, and radiological features in the diagnosis and prognosis of carcinoma ex pleomorphic adenoma: a series of systematic reviews
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Open Access
Type
ThesisThesis type
Masters by ResearchAuthor/s
Key, Seraphina Tze ManneAbstract
Introduction: Carcinoma ex Pleomorphic Adenoma (CXPA) is a rare primary salivary gland malignancy, typically arising from a pre-existing pleomorphic adenoma (PA). The existing literature shows a broad range of survival outcomes, making it difficult to guide timing of surgery for ...
See moreIntroduction: Carcinoma ex Pleomorphic Adenoma (CXPA) is a rare primary salivary gland malignancy, typically arising from a pre-existing pleomorphic adenoma (PA). The existing literature shows a broad range of survival outcomes, making it difficult to guide timing of surgery for its benign counterpart, PA. Aims: This thesis examines clinical, radiological, and pathological features of CXPA which may affect survival outcomes and guide clinical management. Methods: Series of three systematic reviews derived from peer-reviewed and grey literature. Full-text review, data extraction, and risk of bias assessment were conducted by two independent authors. Inclusion criteria were study-specific, but studies examined humans with histological diagnosis of major or minor salivary gland CXPA. All studies were registered prospectively on PROSPERO(CRD42021238544, CRD42022355626, CRD42023421449) Results: Clinical outcomes were examined in 39 studies (n=5637). Median overall survival at one, five, and ten years were 90.0%, 61.9%, and 45.0%. Higher staging, T stage,nodal disease, grading, and invasion ≥1.5mm had worse outcomes. Histological subtype, perineural invasion, and radiotherapy did not show a consistent trend. Molecular factors were examined in 55 studies (n=1322). Examined biomarkers included p53, HER2, AR, EGFR, PLAG1, ERBB,ER/PR, and HMGA2. Predicted incidence was calculated with meta-analysis. Significant differences were shown compared to PA and salivary duct carcinoma. Pre-operative radiological features were examined in 12 studies(n=426). MRI with lower mean ADC values and heterogenous T2 intensity indicated CXPA. Risk of bias was high for molecular and radiology reviews. Conclusions: CXPA is an evolving entity with clinical, radiological, and molecular features which can distinguish it from other malignant salivary gland tumours. Prospective multi-center collaborative studies should be conducted to further explore the therapeutic implications of this rare entity.
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See moreIntroduction: Carcinoma ex Pleomorphic Adenoma (CXPA) is a rare primary salivary gland malignancy, typically arising from a pre-existing pleomorphic adenoma (PA). The existing literature shows a broad range of survival outcomes, making it difficult to guide timing of surgery for its benign counterpart, PA. Aims: This thesis examines clinical, radiological, and pathological features of CXPA which may affect survival outcomes and guide clinical management. Methods: Series of three systematic reviews derived from peer-reviewed and grey literature. Full-text review, data extraction, and risk of bias assessment were conducted by two independent authors. Inclusion criteria were study-specific, but studies examined humans with histological diagnosis of major or minor salivary gland CXPA. All studies were registered prospectively on PROSPERO(CRD42021238544, CRD42022355626, CRD42023421449) Results: Clinical outcomes were examined in 39 studies (n=5637). Median overall survival at one, five, and ten years were 90.0%, 61.9%, and 45.0%. Higher staging, T stage,nodal disease, grading, and invasion ≥1.5mm had worse outcomes. Histological subtype, perineural invasion, and radiotherapy did not show a consistent trend. Molecular factors were examined in 55 studies (n=1322). Examined biomarkers included p53, HER2, AR, EGFR, PLAG1, ERBB,ER/PR, and HMGA2. Predicted incidence was calculated with meta-analysis. Significant differences were shown compared to PA and salivary duct carcinoma. Pre-operative radiological features were examined in 12 studies(n=426). MRI with lower mean ADC values and heterogenous T2 intensity indicated CXPA. Risk of bias was high for molecular and radiology reviews. Conclusions: CXPA is an evolving entity with clinical, radiological, and molecular features which can distinguish it from other malignant salivary gland tumours. Prospective multi-center collaborative studies should be conducted to further explore the therapeutic implications of this rare entity.
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Date
2023Rights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Medicine and Health, Nepean Clinical SchoolAwarding institution
The University of SydneyShare