PD-L1 and PD-L2 Expression in Different Tumor Stages and Types of Malignant Salivary Gland Neoplasms: A Single-center Experience.

There is a limited amount of data on the role of programmed cell death ligand (PD-L) -1 and PD-L2 in salivary gland carcinomas. We aimed to evaluate the prognostic value of PD-L1 and PD-L2 expressions, which are closely related to immune mechanisms, with respect to salivary gland tumor types and stages. Data from patients with salivary gland masses surgically removed between 2006 and 2021, diagnosed with a malignant salivary gland neoplasm, were retrospectively analyzed. Immunoreactivity for PD-L1 and PD-L2 was performed on resection materials. The mean age of 90 patients was 52.1±18.8 and 46.7% were male. Overall, 55.6% of patients were diagnosed with adenoid cystic carcinoma (ACC), 23.3% with mucoepidermoid carcinoma (MEC), 16.7% with acinic cell carcinoma (AciCC), 3.3% with ductal carcinoma (DC), and 1 patient with pleomorphic adenoma ex carcinoma (PA-ex-CA). In all, 52% of ACC, 12% of AciCC, 24% of MEC, and 12% of DC cases were at stage IV. The tumor diameter, frequencies of lymphovascular invasion, metastasis, positive surgical margin, recurrence, and mortality rates of patients at stages III and IV were significantly larger than those at stages I and II ( P <0.05). The percentages of tumor cell score (TCS) and immune cell score (ICS) for PD-L1 were significantly higher among patients with MEC compared with those with other types of tumors ( P =0.0011). However, the percentages of combined score (CS) for PD-L1 and tumor cell score for PD-L2 were comparable among tumor types ( P >0.05). No significant difference was found in these scores for PD-L1 between tumor stages ( P >0.05), but for PD-L2, all patients at stage I had TCS <1% for PD-L2, while all patients at stages II and III, and 92% of patients at stage IV had TCS ≥1% ( P <0.0001). High expression of PD-L1 was mostly observed in MEC cases ( P =0.0016), while all patients with AciCC had a low PD-L1 expression level ( P =0.0206). The mean tumor diameter, rate of lymphovascular invasion, perineural invasion, metastasis, positive surgical margin, recurrence, type of treatment, mortality, and TILs ratio did not differ significantly according to PD-L1 expression level ( P >0.05). The percentage of tumor-infiltrating lymphocytes was comparable among negative and positive PD-L1 scores according to both 1% and 5% threshold values ( P >0.05). High PD-L1 expression is rare in AciCC, while PD-L1 expression is high in MEC. Our findings underline the importance of future screening for PD-L1 and PD-L2 before patients undergoing immunotherapies in all salivary gland tumors.

Prevalence and Causes of Elective Surgery Cancellations After Patients are Taken to the Operating Room: A Prospective, Cross-Sectional Study.

Objective: This study aimed to investigate the causes and prevalence of elective surgery cancellations in the operating room, and the clinical outcomes of affected patients. Methods: This prospective, cross-sectional study assessed the prevalence and causes of elective surgery cancellations once patients are in the operating room. A tertiary academic referral center hosted the study between January 2022 and January 2023. The study sample consisted of 7,482 adult patients scheduled for elective surgeries and taken to the operating room. The 7,415 completed procedures were in Group 2, whereas the 67 cancelled surgeries were in Group 1. Patients were divided into two groups on the basis of whether their surgeries were completed or cancelled. Factors such as age, American Society of Anesthesiologists (ASA) status, and surgical department were analyzed. The two groups were compared on the basis of age, ASA status, surgical department, and surgery time (month and day). Results: Elective surgery cancellations occurred in the operating room at a rate of 0.9%. Group 1 was substantially older than Group 2 (p<0.001). Group 1 had a larger number of ASA III patients (p<0.001). The department with the highest cancellation rate was ophthalmology (2.5%), followed by general surgery (2.1%), urology (1.5%), and ear, nose, and throat (1.4%). It was possible to avoid 59.7% of cancelations. Conclusion: The study revealed a 0.9% prevalence rate of elective surgery cancelations in the operating room. Older age and higher ASA status greatly influenced these cancellations. Optimized surgery scheduling and patient assessment processes may prevent many of these cancellation.