A Comprehensive Analysis of Parotid and Salivary Gland Cancer: Worse Outcomes for Male Gender Michael C. Cheung, M.D.,* Elizabeth Franzmann, M.D.,† Juan E. Sola, M.D.,* David J. Pincus, M.D.,* and Leonidas G. Koniaris, M.D.* ,1 *DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; and †Department of Otolaryngology, University of Miami Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida Submitted for publication September 12, 2009 Background. To determine the effects of patient demographics, socioeconomic status (SES) and clinical variables on outcomes for patients with salivary and parotid gland tumors. Methods. Florida cancer registry and inpatient hos- pital data were queried for cancer of the salivary glands diagnosed between 1998 - 2002. Results. A total of 1573 patients were identified. Women were diagnosed at a younger age (median age (years): women 60.8 versus men 64.3, P [ 0.003). Men were more often diagnosed with high grade tumors (65.1% versus 41.9% for women, P < 0.001) and advanced disease stage (>stage III: 60.2 versus 49.4%, P < 0.001), but underwent surgical extirpation and re- ceived radiation at equal rates compared with women. Overall 5-year survival rates was superior in women (67.4% versus 55.6%, P [ 0.001). By multivariate analy- sis, adjusted for patient comorbidities, age over 65 (HR 3.43 P [ 0.008), advanced disease stage (HR 8.05 P < 0.001), and high tumor grade (HR 2.33, P < 0.001) were independent predictors of worse prognosis. Im- proved outcomes were observed for female gender (HR 0.68, P [ 0.011). Tumors located in the parotid gland (HR 0.631 P [ 0.003) and receiving both surgical extirpation and radiation were predictors of improved survival. Conclusion. Salivary gland tumors carry a worse prognosis than tumors of the parotid. Male patients have worse outcomes. Ó 2011 Elsevier Inc. All rights reserved. Key Words: parotid; salivary gland; gender dispar- ities; outcomes. INTRODUCTION Salivary glands cancers represent 3%–6% of all head and neck cancers and 0.3% of cancers over all [1]. These cancers occur in the major salivary glands, including the parotid, submandibular, and sublingual glands, and in the minor salivary glands located throughout the upper aerodigestive tract (UADT). The parotid is the most common site and accounts for 1% to 3% of all head and neck carcinomas [2]. Salivary malignancies are heterogeneous neoplasms with differing histologic features requiring multimodal forms of treatment [3]. The most common histologies in- clude mucoepidermoid, adenocarcinoma, adenoid cystic carcinoma, and acinic cell carcinoma. Malignant mixed tumor, squamous cell carcinoma (SCC), and undifferen- tiated carcinoma have also been reported [4, 5]. Treat- ment has primarily remained surgical, and is usually followed by radiotherapy for aggressive histologies. The role of chemotherapy and molecular targeted agents is currently under investigation [4]. Previous studies have demonstrated higher inci- dence rates of UADT for black males and lower overall survival for blacks compared with whites [6]. Dispar- ities in patient cancer outcomes remain a significant healthcare problem in America, and for many malig- nancies the root cause for disparate patient cancer out- comes, including those undergoing palliative therapies, remain poorly understood and understudied. In addi- tion, comorbidity has also been shown to be a predictor of survival in head and neck carcinoma [7]. We sought to determine the effects of patient demographics, including gender, socioeconomic status (SES), race, comorbidities, and other clinical variables on patient 1 To whom correspondence and reprint requests should be ad- dressed at University of Miami School of Medicine, 3550 Sylvester Comprehensive Cancer Center 1475 NW 12 th Avenue, Miami, FL 33136. E-mail: lkoniaris@med.miami.edu. 0022-4804/$36.00 Ó 2011 Elsevier Inc. All rights reserved. 151 Journal of Surgical Research 171, 151–158 (2011) doi:10.1016/j.jss.2009.11.721