Impact of tumor site and diagnostic pathway on stage at diagnosis: A population-based study of 5,638 salivary gland cancer patients (2013–2023).

Abstract

e18140 Background: Salivary gland cancer (SGC) are rare and heterogeneous malignancies. Delays in diagnosis are common and are associated with more advanced disease at presentation, increasing the risk of inoperability and of recurrent or metastatic disease following surgery. Methods: We analysed aggregated national cancer registry data (NDRS) for salivary gland cancers diagnosed in England between 2013 and 2023. Cases with known stage (TNM stages 1–4) were included. Squamous cell carcinoma of the major salivary glands was excluded. Stage at diagnosis was categorised as early (stages 1–2) or late (stages 3–4). Tumour site was grouped as major salivary glands (major) versus minor salivary glands from the head and neck (minor). Multivariable logistic regression was used to assess associations with late-stage diagnosis, adjusting for age group, sex, and route to diagnosis. Additional sensitivity analyses excluded emergency presentations and, separately, restricted analyses to planned diagnostic pathways; urgent suspected cancer pathway (USC), a fast tracked cancer specific referral pathway vs other General practitioner (GP) referrals. Results: A total of 5,638 patients with SGC were identified. Late stage at diagnosis was seen in 49.3%. Emergency presentation was strongly associated with late-stage diagnosis. In multivariable analyses adjusting for age, sex and diagnostic pathway, patients with major SGC were significantly less likely to be diagnosed at a late-stage than those with SGC of other sites (adjusted OR 0.46, 95% CI 0.46–0.47 ); this association persisted after exclusion of emergency presentations and in analyses restricted to planned diagnostic routes. Within planned pathways, patients referred via the USC pathway were significantly more likely to be diagnosed with late-stage disease compared with those referred via a GP referral (adjusted OR 1.13, 95% CI 1.12–1.13). Conclusions: In this national study of 5,638 patients diagnosed with salivary gland cancer in England over a 10-year period, stage at diagnosis was strongly associated with both tumour site and diagnostic pathway. Major salivary gland tumours were consistently less likely to be diagnosed at a late stage whereas emergency presentation was strongly associated with advanced disease. Notably, within planned diagnostic pathways, referral via the Urgent Suspected Cancer pathway was associated with a higher likelihood of late-stage diagnosis compared with GP referral, suggesting that patients meeting current USC criteria may already have clinically advanced disease at the time of referral. These findings highlight the need to optimise earlier recognition and referral of salivary gland cancers to reduce late-stage diagnosis.