Refining Prognostic Stratification in Head and Neck Paragangliomas: Insights from a SEER-Based Population Study.

Abstract

Objectives: Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors with heterogeneous behavior, making prognostic assessment challenging. Although generally indolent, a subset exhibits malignant potential, and robust prognostic determinants remain insufficiently defined. This study aimed to identify clinical and pathological factors independently associated with overall survival (OS) in patients with HNPGLs.

Methods: We performed a retrospective Surveillance, Epidemiology, and End Results (SEER)-based cohort study (1975-2021). Demographic, clinicopathologic, and treatment variables were evaluated using Kaplan-Meier survival estimates, Cox regression models, and receiver operating characteristic (ROC)-derived cutoffs.

Results: Among 280 patients, most tumors originated in the carotid body (77.5%). In univariable analyses, extra-carotid location, tumor size ≥ 34.5 mm, absence of surgery, advanced stage, and older age were associated with poorer OS. In multivariable analysis, older age, advanced stage, and lack of surgery remained independently associated with reduced OS.

Conclusions: Age at diagnosis, disease stage, and surgical resection status were independently associated with OS, with stage emerging as the strongest determinant in HNPGLs. Associations involving tumor size and extra-carotid location should be interpreted as exploratory findings.