Extracapsular invasion: A potential prognostic marker for Carcinoma ex-pleomorphic adenoma of the salivary glands? A Systematic Review

Background The aim of the present study was to integrate available data published in the literature on extracapsular invasion in cases of CXPA that correlated findings with the prognosis of analysed patients. Methods An electronic search was carried out at the MEDLINE/PubMed, EMBASE and Cochrane Collaboration Library databases. Articles that assessed the relationship between extracapsular invasion and survival of patients diagnosed with CXPA were selected for the systematic review. Quality assessment was performed, in duplicate, for each eligible study by independent reviewers who used the operationalized prognostic biomarker reporting the REMARK guidelines. Results Eight published articles met all the inclusion criteria and were selected. Extracapsular invasion was evaluated in all selected studies and was correlated with clinical and pathological parameters. Recurrence and death due to the neoplastic process became a frequent finding in cases of tumours with extracapsular invasion >1.5 mm, being an important cut-off point in the prognostic analysis of cases diagnosed as CXPA. Conclusions This systematic review demonstrates the importance of evaluating extracapsular invasion in cases diagnosed as CXPA, considering that tumours with invasion >1.5 mm, regardless of histopathological subtype, are associated with a worse prognosis. It is important to analyse the extracapsular invasion, especially as an auxiliary method to assess the prognosis of cases diagnosed in the initial clinical stages, thus identifying the possible biological behaviour of the neoplastic process and guiding the most appropriate patient management.