Salivary gland carcinoma in Denmark 1990–2005: A national study of incidence, site and histology. Results of the Danish Head and Neck Cancer Group (DAHANCA)

doi:10.1016/j.oraloncology.2011.04.020

Oral Oncology

Volume 47, Issue 7, July 2011, Pages 677-682

https://doi.org/10.1016/j.oraloncology.2011.04.020 Get rights and content

Summary

To describe the incidence, site and histology (WHO 2005) of salivary gland carcinomas in Denmark. Nine hundred and eighty-three patients diagnosed from 1990 to 2005 were identified from three nation-wide registries. The associated clinical data were retrospectively retrieved from patient medical records. Histological revision was performed in 886 cases (90%). Based on histological revision, 31 patients (3%) were excluded from the study leaving 952 for epidemiological analysis. The mean crude incidence in Denmark was 1.1/100,000/year. The male vs. female ratio was 0.97 and the median age was 62 years. The parotid gland was the most common site (52.5%) followed by the minor salivary glands of the oral cavity (26.3%). The most frequent histological subtypes were adenoid cystic carcinoma (25.2%), mucoepidermoid carcinoma (16.9%), adenocarcinoma NOS (12.2%) and acinic cell carcinoma (10.2%). The revision process changed the histological diagnosis in 121 out of 886 cases (14%). The incidence of salivary gland carcinoma in Denmark is higher than previously reported. More than half of salivary gland carcinomas are located in the parotid gland with adenoid cystic carcinoma being the most frequent subtype. Histological classification of salivary gland carcinomas is difficult and evaluation by dedicated pathology specialists might be essential for optimal diagnosis and treatment.

Introduction

Salivary gland carcinoma is a rare and very heterogeneous disease. According to the NORDCAN project under the Association of the Nordic Cancer Registries (ANCR),¹ the mean number of new Danish cases in the time period from 2004 to 2008 was 51 per year indicating a crude incidence of 0.9/100,000/year.

In 1972, the first WHO classification of salivary gland carcinomas was published including six histopathological subtypes and a residual category of adenocarcinoma NOS (not otherwise specified).² Since then, the knowledge of these carcinomas has increased and the classification has become more detailed. The second WHO classification by Seifert³ was published in 1991 describing 17 histological subtypes and finally, the recent classification from 2005⁴ covers 24 histological subtypes with different malignant potential and prognosis.

To reach sufficient data for evaluation of epidemiology and histopathology, collection of cases during a long time period is necessary. Several studies have included a significant number of patients. Some of these are national[5], [6], [7] and some have been through a histological revision process,[5], [8], [9], [10], [11] but only one study from Finland is national and includes histological revision of the diagnosis. The diagnosis and sub classification of these carcinomas is a great challenge for the pathologists. Studies have shown that changes from malignant to benign as well as changes in between subtypes occur if histological revision is performed.[5], [12]

The purpose of this study is to present incidence, site and histology in a national series of Danish patients with salivary gland carcinoma and to describe possible changes induced by histological revision.

Section snippets

Material and methods

Patients diagnosed with a primary salivary gland carcinoma from January 1990 to December 2005 were identified from three Danish national registries: The Danish Cancer Registry, The Danish Pathology Registry and The Danish Patient Registry. All cancers in Denmark are reported to The Danish Cancer Registry, and since 1987, reporting of data has been mandatory. The Danish Pathology Registry is a national database including all histological and cytological reports in Denmark. The Danish Patient

Results

During the revision process, eleven carcinomas were revised to a benign diagnosis. In seven cases, carcinoma ex pleomorphic adenoma was revised to carcinoma in situ ex pleomorphic adenoma, and they were also excluded. Twelve of the salivary gland carcinomas were revised to other types of malignant tumors. One adenosquamous carcinoma in the floor of the mouth was also excluded since this tumor is not included in the salivary gland carcinoma WHO 2005 classification. In ninety cases, revision

Discussion

To achieve sufficient data for evaluation of epidemiological information and clinical outcome of salivary gland carcinomas, collection of cases during a long time period is necessary. The quality of information might be compromised by the increasing number of subtypes in the WHO classification during the years. This might cause undesirable differences among studies, and even within the same study, if the registration period has been long and the evaluation has not included histological

Conclusion

The incidence of salivary gland carcinoma in Denmark is higher than previously reported. We found an average of 62 new cases per year from 2000 to 2005. None of the Danish registries have complete coverage of the population but when merging these registries, completeness is improved.

The sex distribution is equal and the median age at time of diagnosis is 62 years. The age range is 8–102 years. In Denmark, the parotid gland is the most common primary site followed by the minor salivary glands, the

Conflicts of interest statement

None declared.

Acknowledgements

The study was financially supported by the Danish Head and Neck Cancer Group (DAHANCA) and the Faculty of Health Sciences, University of Southern Denmark.

The study was approved by the local Ethics Committee and was conducted in accordance with the Danish law for scientific ethics committee.

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Salivary gland carcinoma in Denmark 1990–2005: A national study of incidence, site and histology. Results of the Danish Head and Neck Cancer Group (DAHANCA)

Summary

Introduction

Section snippets

Material and methods

Results

Discussion

Conclusion

Conflicts of interest statement

Acknowledgements

Oral Oncol

Oral Oncol

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Otolaryngol Head Neck Surg

Histologic typing of salivary gland tumours. WHO international classification of tumours

Histological typing of salivary gland tumours. WHO International Histological Classifi–––cation of Tumours

World Health Organization classification of tumors: pathology and genetics of head and neck tumors

Salivary gland cancer in Finland 1991–96: an evaluation of 237 cases

Acta Otolaryngol

Salivary gland carcinomas–prognostic factors

Acta Oncol