title: Salivary gland pleomorphic adenoma in the Netherlands: A nationwide observational study of primary tumor incidence, malignant transformation, recurrence, and risk factors for recurrence.
abstract: Whereas salivary gland pleomorphic adenoma (SGPA) is the most common type of salivary gland tumor, little is known about its epidemiology because national cancer registries do not register this disease.
  
  
  
  To establish SGPA incidence trends, rates of secondary malignant transformation and recurrence and associated factors in the Netherlands.
  
  
  
  Data on incidence, epidemiology, secondary malignant transformation and recurrence were retrieved from the Dutch pathology registry (PALGA) for the years 1992, 1997, 2002, 2007, and 2012. Multivariate analysis was performed to discover the risk factors for recurrence.
  
  
  
  3506 cases of SGPA were recorded implying an overall European standardized rate of 4.2-4.9 per 100,000 person-years. Our figures showed a female preponderance (1:1.43) with an annual 1% rise in female incidence (95% confidence interval [CI]: 0.2-1.8) and a bimodal age distribution in women (p<0.0001). The overall 20-year recurrence rate was 6.7%, and median time to first recurrence was 7years. Positive and uncertain resection margins and younger age at diagnosis were risk factors for recurrence, with odds ratios (ORs) of 4.62 (95%CI 2.84-7.51), 4.08 (95%CI 2.24-7.43), and 0.42 (95%CI 0.29-0.63) respectively. Tumor locations in the minor salivary glands had lower odds of recurrence than tumors in the parotid (OR 0.24; 95% CI: 0.07-0.77; p<0.016). Malignant transformation occurred in 0.15% of SGPAs (3.2% of recurrences).
  
  
  
  This first nationwide study clearly showed sex differences in SGPA epidemiology, possibly suggesting some underlying hormonal mechanism. Long-term recurrence risks were low, and secondary malignant transformation risks were very low.
authors.affiliation: Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands. Electronic address: m.valstar@nki.nl.
authors.forename: M H
authors.initials: MH
authors.lastname: Valstar
authors.affiliation: Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Radiotherapy, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Ridder
authors.affiliation: The Nationwide Network and Registry of Histo - and Cytopathology in the Netherlands (PALGA), Houten, The Netherlands.
authors.forename: E C
authors.initials: EC
authors.lastname: van den Broek
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M M
authors.initials: MM
authors.lastname: Stuiver
authors.affiliation: Department of Research, Comprehensive Cancer Organisation (IKNL) The Netherlands, Utrecht, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Centre, Groningen, The Netherlands.
authors.forename: B A C
authors.initials: BAC
authors.lastname: van Dijk
authors.affiliation: Department of Pathology Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: M L F
authors.initials: MLF
authors.lastname: van Velthuysen
authors.affiliation: Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: A J M
authors.initials: AJM
authors.lastname: Balm
authors.affiliation: Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: L E
authors.initials: LE
authors.lastname: Smeele
mesh_terms: D008949:Adenoma, Pleomorphic / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D012468:Salivary Gland Neoplasms / Q000453:epidemiology*; D055815:Young Adult
keywords: Carcinoma ex pleomorphic adenoma; Epidemiology; Head and neck neoplasms; Hormone; Incidence; Malignant transformation; Pleomorphic adenoma; Recurrence; Risk factor; Salivary glands