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Xiao et al

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The detection of nodal disease preoperatively will also depend on availability of computed tomography, com puted tomography/positron emission tomography, and magnetic resonance imaging quality and radiologic exper tise, which varies among hospitals and may have been used in obtaining staging criteria. 34 Lack of clinical and histologic variables that others have studied and analyzed as predictors of nodal disease (eg, perineural spread, intraparotid lymph node involvement, 35 facial nerve involvement 20 ) disallows us from using those data in our multivariate regressions. Lastly, we are limited to OS data, which may be confounded by comorbid disease and other causes of death. Conclusion The most common parotid gland malignancies include mucoepidermoid carcinoma, acinar cell carcinoma, and ade nocarcinoma NOS. The incidence of lymph node metastasis is highest in salivary ductal carcinoma. Regional nodal metastasis significantly decreases OS in many parotid malignancies, providing evidence for further treatment of the neck in these tumors. T stage and grade are both signifi cant independent predictors of nodal metastasis for most histopathologies. Low-grade variants of all histopathologies had occult nodal incidences \ 10%. These prognostic indi cators may be helpful in decision making regarding treat ment of the neck and adjuvant therapy options in parotid gland malignancies. Authors’ Note The data used in the study are derived from a de-identified National Cancer Data Base file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed or the conclusions drawn from these data by the investigator. Author Contributions Christopher C. Xiao, conception and design, collection and inter pretation of data, drafting and revising of manuscript, final approval of manuscript; Kevin Y. Zhan, conception and design, collection and interpretation of data, drafting and revising of manu script, final approval of manuscript; Shai J. White-Gilbertson, conception and design, collection and interpretation of data, draft ing and revising of manuscript, final approval of manuscript; Terry A. Day, conception and design, collection and interpretation of data, drafting and revising of manuscript, final approval of manuscript.

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Disclosures Competing interests: None. Sponsorships: None. Funding source: None.

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