Disparities in pediatric parotid cancer treatment and presentation: A National study.

OBJECTIVES: Although parotid gland malignancies are uncommon, they nevertheless represent a cause of morbidity and mortality in the pediatric population. Few studies have sought to identify disparities related to their presentation, treatment, and survival. There is a need to understand these variations to improve care for historically underrepresented groups. STUDY DESIGN: Retrospective Cohort Study. SETTING: Surveillance, Epidemiology, and End Results (SEER) Program Database. METHODS: Analysis of pediatric patients with parotid gland malignancies between 2000 and 2019. Race and ethnicity were classified as Non-Hispanic White, Non-Hispanic Black, Asian, and Hispanic for multivariable analysis. Outcomes included tumor size and stage at diagnosis, survival, and need for facial nerve sacrifice. Kaplan-Meier analysis was used to analyze survival. Multivariable logistic regression was conducted to identify predictors of outcomes. RESULTS: 149 patients met the criteria for inclusion. Stratified by race/ethnicity, Non-Hispanic Black (Median 23 mm, IQR 15-33), Asian (30 mm, 14-32), and Hispanic (23 mm, 20-28) patients had larger tumors at presentation than Non-Hispanic White patients (18 mm, 12-25, p = 0.017). Disease-specific survival differed by time-to-treatment (log-rank, p = 0.01) and overall survival differed by income (p < 0.001). On multivariable analysis, Hispanic patients were more likely to experience facial nerve sacrifice (OR 3.71, 95%CI 1.25-11.6, p = 0.020), and Non-Hispanic Black (OR 3.37, 0.95-11.6, = 0.053) and Asian (OR 5.67, 1.46-22.2, p = 0.011) patients presented with larger tumors compared to Non-Hispanic White patients. CONCLUSIONS: Variations in presentation and treatment exist across race and ethnicity in pediatric parotid cancer. Identifying these disparities may help improve access and outcomes for underserved patient populations. LEVEL OF EVIDENCE: III.

Rare Presentation of Acinic Cell Carcinoma in the Parotid Gland.

Acinic cell carcinoma (ACC) arising in the salivary glands is a rare tumor. It is a low-grade malignant salivary gland tumor. It is predominantly seen in females and occurs in the fifth and sixth decades of life. It is mostly located in the parotid gland. ACC has a significant potential for recurrence and metastasis. Therefore, long-term follow-up is necessary after treatment. Here, a 28-year-old male presented with right preauricular swelling for 9 months. Ultrasound of the head-and-neck region and fine-needle aspiration cytology of preauricular swelling suggest the diagnosis of neoplasm in the parotid gland, most probably a benign tumor. After that, a total parotidectomy with facial nerve preservation was performed. On histopathological and immunohistochemical study was consistent with the diagnosis of ACC in the parotid gland.

RésuméLe carcinome à cellules aciniques (ACC) survenant dans les glandes salivaires est une tumeur rare. Il s'agit d'une tumeur de la glande salivaire maligne à faible teneur. Il est principalement observé chez les femmes et se produit dans les cinquième et sixième décennies de la vie. Il est principalement situé dans la glande parotide. ACC a un potentiel important pour la récidive et les métastases. Par conséquent, un suivi à long terme est nécessaire après le traitement. Ici, un homme de 28 ans a présenté un gonflement préauriculaire droit pendant 9 mois. Échographie de la région de la tête - et du pic et de la cytologie de l'aspiration fine Le diagnostic du néoplasme dans la glande parotide, très probablement une tumeur bénigne. Après cela, une parotidectomie totale avec préservation du nerf facial a été effectuée. Sur l'étude histopathologique et immunohistochimique, était conforme au diagnostic de l'ACC dans la glande parotide.

[Research progress in accessory parotid gland tumor surgery].

In salivary gland disease, accessory parotid gland (APG) lesions are relatively low, and tumor is the most common manifestation. Currently, surgery is the primary treatment method for APG tumors. Although numerous surgical procedures are available, there is no standard protocol. Due to the location of the APG in the midcheek area, the complications and aesthetic concerns connected with conventional surgery for treating APG tumors sometimes cause significant distress to patients. With the progress of medical technology as well as improving patients' aesthetic and functional requirements, surgical excision methods and incision design are constantly improving. More beautiful and minimally invasive treatments, such as concealed transoral approach and endoscopically aided extracapsular dissection of APG, have been gradually developed. This review focuses on surgical techniques, benefits, and drawbacks of APG tumor surgery that have been carried out and provides an outlook based on the preliminary application of endoscopically assisted accessory parotid tumor resection.

Successful treatment of trichilemmal carcinoma with distant metastasis using pembrolizumab: a case report and review.

Trichilemmal carcinoma (TC) is a rare, malignant cutaneous adnexal tumor. TC often has nonspecific clinical manifestations and its aggressive nature is frequently overlooked. Metastasis of TC is rarely reported and there is no standard treatment for recurrent or metastatic TC. We report a complicated case of TC arising from the parotid gland with metastasis to cervical lymph nodes. The tumor progressed after multiple surgeries, radiation and chemotherapy. Finally, the patient achieved good response and disease control with pembrolizumab, an immune checkpoint inhibitor targeting programmed cell death protein-1. Currently, the patient has received 19 cycles of pembrolizumab and the disease remains well controlled. This represents the first reported use of immune checkpoint blockade to treat TC.

This paper discusses a rare form of skin cancer called trichilemmal carcinoma (TC) and presents a distant metastasis TC case. The patient was treated with an immunotherapy called pembrolizumab and after 19 courses of treatment, the tumor was significantly reduced and the symptoms were relieved. This case report is the first recorded case study of pembrolizumab for the treatment of TC and provides a new approach to the treatment of challenging malignancies.

[Application of modified Z-shaped cosmetic incision in parotid benign tumor resection].

Objective:To explore the safety and aesthetic effect of modified Z-shaped cosmetic incision in parotid benign tumor resection. Methods:A prospective study was conducted. A total of 44 patients with benign parotid tumor resection were randomly divided into experimental group（n=22） and control group（n=22）. The experimental group underwent modified Z-shaped cosmetic incision, while the control group underwent the traditional S-shaped incision. The surgical duration, hospital stay, complications and maxillofacial aesthetics were compared between the two groups. Results:There was no significant difference in gender, age, surgical method, pathological type between the experimental group and the control group（P>0.05）. The maxillofacial aesthetics and surgical duration of the two groups was statistically significant（P<0.05）, while there was no statistically significant difference in terms of hospitalization days, surgical complications and Vancouver scar scale score （P>0.05）. Conclusion:The modified Z-shaped cosmetic incision has a better effect on improving the maxillofacial aesthetics after benign parotid tumor resection, and compared with the traditional S-shaped incision, the safety is consistent, so it is worthy of clinical promotion and application.

Warthin tumor concomitant with mantle cell lymphoma: a case report and review of literature.

RATIONALE: Warthin tumor (WT) is the second most common benign tumor in salivary gland. It has a slow growth rate and most frequently occurs in the parotid gland. Most patients present with an incidental finding of a painless mass inferior/anterior to the ear. Besides the epithelial component of the tumor, WT is characteristically associated with lymphoid stroma that is considered benign. While there have been a few reports of malignant transformation of the lymphoid components in WT, cases of WT concomitant with mantle cell lymphoma (MCL) are extremely rare. To the best of our knowledge, two cases have been described in the English literature. Herein, we report a case of WT concomitant with MCL in a 70-year-old female patient, and emphasize the importance of careful examination of lymphoid stroma in WT so that concurrent lymphoma is not missed. PATIENT CONCERNS: A 70-year-old Chinese woman with a 40-year history of cigarette smoking presented with a one year history of a right submaxillary mass with recent enlargement. DIAGNOSIS: Cervical ultrasound (US) and computed tomography (CT) scans of the neck revealed a well-circumscribed mass in the right parotid with a maximum diameter of 3.1 cm. Surgical resection of the mass was performed. Histopathological examination revealed a characteristic double-layer of neoplastic epithelium with prominent lymphoid stroma, suggesting WT. In addition, morphology and immunohistochemistry studies confirmed the coexistence of MCL. Thereafter, the final diagnosis of this case was WT concomitant with MCL. INTERVENTIONS: The patient was staged as stage I after clinical assessment. Due to the slow growth of parotid lesions, close observation was decided with periodic clinical and radiological monitoring. OUTCOMES: Currently, the patient demonstrates a stable disease by clinical evaluation. LESSONS: To the best of our knowledge, reported cases of WT concomitant with MCL are very rare. This case highlights the importance of a comprehensive assessment of the lymphoid stroma of WT to avoid missed diagnosis of a lymphoma component in a collision tumor.

A Review of Surgical Incisions Used for the Excision of Benign Parotid Tumors.

OBJECTIVE: To provide surgical references for selecting appropriate parotidectomy incisions, reviewing modified approaches, incision designs, and associated complications. METHODS: We have systematically searched 5 medical literature databases examining parotidectomy incision designs and postoperative complications from 2008 to 2021. RESULTS: There are a total of 9 novel incision designs: 1) posterior auricular hairline incision (PAHI); 2) combined preauricular and retroauricular incision (CPRI); 3) V-shaped incision (VI); 4) N-shaped incision (NI); 5) postaural incision (PI); 6) preauricular crutch incision (PCI); and 7) endaural incision (EI). Simultaneously, there are a total of 8 postoperative complications: 1) infection; 2) salivary fistula; 3) facial nerve palsy/paresis; 4) ear lobule numbness; 5) Frey syndrome; 6) facial deformity; 7) hematoma; and 8) tumor reoccurrence. CONCLUSIONS: Over the last decade, a surge in modified parotidectomy incisions has been witnessed in clinical practice. This expansion is attributed to rapid technical advancements and a deeper understanding of anatomy and histopathology. These modified approaches contribute significantly to improving cosmetic outcomes, minimizing associated complications, and enhancing patient satisfaction.

Low Radiation Doses in Oncocytic Lesions of the Parotid Gland: A Double-edged Sword. A Comprehensive Review.

Oncocytic lesions represent a group of benign and potentially precancerous tumors characterized by the accumulation of oncocytes, which are large, granular, and eosinophilic cells. Diagnosing oncocytic lesions in the parotid gland typically involves a combination of imaging techniques, such as ultrasound, Computed Tomography (CT) scans, and Magnetic Resonance Imaging (MRI). Fine-needle aspiration (FNA) biopsy with histopathological examination remains the primary diagnostic tool for these lesions. Accurate diagnosis is crucial for appropriate management decisions. Treatment options for oncocytic lesions in the parotid gland include surgery, conservative management, and radiation therapy (RT). However, in the head and neck region, radiation doses can be a double-edged sword. While RT is a treatment modality, low radiation doses can promote the development of oncocytic lesions in the parotid gland. The prognosis for patients with oncocytic lesions is generally favorable, especially when the lesions are benign and appropriately managed. Current research focuses on the molecular mechanisms underlying oncocytic lesions in response to low-dose radiation exposure. The development of these lesions following low radiation doses represents a significant clinical concern. This manuscript provides a comprehensive overview of the current knowledge regarding oncocytic lesions in the parotid gland, including risk factors, diagnosis, treatment options, and ongoing research, offering valuable insights for clinicians and researchers.

SMAS flap for extracapsular dissection of parotid gland tumors: is it necessary?

OBJECTIVE: The aim of this retrospective article is to evaluate postoperative outcomes after extracapsular dissection for small benign superficial parotid neoplasms (<3 cm) in patients who received Superficial Musculoaponeurotic System (SMAS) flap and in patients who did not receive it. METHODS: Two groups were created and statistically compared regarding Frey's syndrome and aesthetic satisfaction by data collected through the POI-8 validated questionnaire and through an aesthetic satisfaction scale ranging from 1 to 10. The difference between these two groups was the utilization of SMAS flap. SMAS flap was harvested in one of these two group, meanwhile was not used in the other. RESULTS: The p-value analysis between group 1 and group 2 on these complications, resulted statistically not significant. Also, the aesthetic satisfaction resulted not statistically significant between group 1 and group 2. Gender, localization, and facial palsy resulted statistically correlated with the aesthetic satisfaction (p-value < 0.05). CONCLUSION: In conclusion, there is no statistical difference in the use of SMAS flap for benign parotid neoformations of the superficial lobe, with a diameter of less than 3 cm for which extracapsular dissection is adopted as a surgical technique.

An autopsy case of pulmonary tumor thrombotic microangiopathy that developed during chemotherapy for salivary duct carcinoma of the parotid gland.

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rapidly progressive cancer-related disease with a dismal clinical course. The patient in this report was a 43-year-old man with metastatic salivary duct carcinoma arising from the parotid gland. Combined androgen blockade therapy was administered started as first-line treatment, but failed after 5 months, followed by docetaxel plus carboplatin therapy as second-line treatment, which failed after 3 months. Genomic profiling revealed a BRAF V600E mutation, and combined BRAF and MEK inhibitor therapy was started as third-line treatment. The cancer remained stable during the first 10 months of third-line treatment, but treatment was subsequently discontinued due to the onset of symptoms of fatigue, myalgia and arthritis. Twenty days after the onset of these symptoms and interruption of third-line treatment, the patient was urgently admitted to hospital with respiratory distress and severe thrombocytopenia. CT images at the time of admission led our radiologist to the possibility of PTTM, but the patient died the day after admission and autopsy findings indicated that PTTM was the cause of death. This report describes a very informative case of PTTM with sequential imaging and detailed autopsy findings were available and provides a literature review.

Navigating the void: outcomes and adaptations during parotid surgery in the absence of posterior belly of digastric muscle.

It is well known that the digastric posterior belly is one of the essential landmarks for facial nerve identification during parotid surgery. While there were multiple reports about variations of the digastric anterior belly, only a few anatomical variations of the posterior belly of the digastric muscle have been described.In this article, we describe an anatomical variation of the posterior belly of digastric muscle found during superficial parotidectomy of a patient with pleomorphic adenoma. This anatomical variation also led to an anatomical variation in the position of the facial nerve.To our knowledge, this is the first report of an absent posterior belly of digastric muscle found during live parotid surgery. The knowledge of current anatomical variation may help to avoid facial nerve injury during parotid surgery and preserve the function of muscles of facial expression.

Carcinoma ex-pleomorphic adenoma of parotid gland presenting as a gigantic cervicofacial mass.

When neglected for a long time, salivary gland pleomorphic adenoma (PA) can attain a considerable size, increasing the patient's morbidity along with the risk of malignant transformation. Very few case reports are available describing PA of the parotid glands presenting as a large cervicofacial mass. We report a case of epithelial myoepithelial carcinoma -a rare subtype of carcinoma ex-PA (Ca-Ex-PA) of non-luminal differentiation, that developed over a long period in a primary PA of the parotid gland and presented as a giant cervicofacial mass.

Parotid Gland Tumors: Molecular Diagnostic Approaches.

Parotid gland pathology represents a web of differential diagnoses. There are many complex cases that require extensive diagnostic tests for a complete and correct final pathology diagnosis. Currently the official classification of parotid gland tumors extends over more than 40 subtypes. We performed a query of the PubMed database regarding the use of molecular biology tests in performing a better characterization of the tumors in specific cases. By using fluorescence in situ hybridization (FISH), reverse transcription polymerase chain reaction (RT-PCR) or next-generation sequencing, the team managing complex cases can offer a personalized therapeutic solution. We review the molecular differential diagnosis according to published articles in the last 5 years for many types of parotid gland tumors ranging from benign to borderline malign tumors to malign aggressive tumors. Mucoepidermoid carcinoma is a distinct subtype of parotid malignancy that was the subject of a consistent number of articles. However, the molecular biology diagnosis techniques helped more in excluding the diagnosis of mucoepidermoid carcinoma, and probably retrospectively limiting the number of cases with this final diagnosis. In Romania, the molecular biology diagnosis is available only in limited research facilities and should receive more consistent funding that will make it available on a larger scale. The novelty of this scoping review is that we propose an algorithm for molecular differential diagnosis of the tumors that could be encountered in the parotid gland.

[Imaging findings in 12 cases of Warthin-like mucoepidermoid carcinoma].

PURPOSE: To summarize the ultrasound, CT and MRI manifestations of Warthin-like mucoepidermoid carcinoma (WT-MEC), and to explore its imaging characteristics, so as to provide reference for clinical and preoperative diagnosis. METHODS: The clinical information and imaging data of ultrasound, CT and MRI of 12 patients with WT-MEC diagnosed by pathology in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2017 to December 2021 were collected, and their specific characteristics were retrospectively summarized. RESULTS: Among the 12 WT-MEC patients, there were 7 males and 5 females, with an average age of (42.7±16) years. Seven cases underwent ultrasound examination, 6 cases underwent CT examination, and 2 cases underwent MRI examination. Radiologically, all the lesions presented as a solitary mass. 11/12 lesions(91.7%) were identified as well-defined margins, and 10/12(83.3%) as solid-cystic masses. All solid-cystic lesions contained multiple cystic areas with variable sizes. On US images, most lesions showed mixed-echoic echogenicity(5/7, 71.4%), poor vascularization (6/7, 85.7%) and acoustic enhancement (6/7, 85.7%). CT revealed all the lesions (6/6, 100%) as a soft-tissue mass with heterogeneous enhancement (5/6, 83.3%). MRI imaging demonstrated the neoplasm with low or iso-signal intensity on plain T1WI and hyperintensity on T2WI. The heterogeneous enhancement was shown on contrast-enhanced T1WI. CONCLUSIONS: Most WT-MECs represent as a solitary, well-defined, solid-cystic mass in the parotid gland. The neoplasm may be characterized by the multiple and variable-sized cystic components within the tumor.

Impact of childhood/adolescent cancer history on prognosis in parotid mucoepidermoid carcinoma.

Our goal was to assess the impact of childhood/adolescent cancer history on overall survival (OS) and disease-specific survival (DSS) in patients with parotid mucoepidermoid carcinoma (MEC). Patients who underwent surgical treatment for primary parotid MEC and those with a second malignancy of parotid MEC were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database. The primary outcome variables were OS and DSS. The hazard ratios (HRs) of these survival rates associated with cancer history were analysed using Cox regression models. In total, 2681 patients were included, 263 of whom had a second malignancy. The 10-year OS rates in the primary (72%) and second malignancy groups (59%) were significantly different. Cox regression confirmed that a history of cancer tended to decrease OS (p = 0.062, HR: 1.28, 95% confidence interval: 0.99 to 1.64). Subgroup analyses showed that a history of solid tumour as opposed to haematological cancer predicted worse OS, with central nervous system tumours exhibiting a more significant influence than others (p = 0.030 vs p = 0.088). Cancer history was not related to DSS. A history of childhood/adolescent cancer negatively influenced the prognosis of patients with parotid MEC, and this effect was primarily driven by a history of solid malignancy.

Fingertip cutaneous metastasis of salivary duct carcinoma secondary to scald: A unique case report and a brief review of literature (following CARE guidelines).

RATIONALE: Salivary duct carcinoma (SDC) is an aggressive form of cancer, with cutaneous metastasis being a rare occurrence. Furthermore, cutaneous metastasis of SDC secondary to a scald is even rarer, and to the best of our knowledge, our case represents the first such instance. Considering the involvement of the fingers in the metastatic site, which may affect limb function and quality of life, we present this case to explore the reason why scald could lead to distant recurrence and better treatment options. PATIENT CONCERNS: An 85-year-old man diagnosed with SDC in the parotid gland found enlarged masses at the fingertips as a consequence of a burn, 6 years after his initial treatment. DIAGNOSES: Cutaneous metastasis of SDC in the parotid gland and left thumb loss due to surgery. INTERVENTIONS: Radiotherapy was offered, targeting at the masses on the fingers, with dose at 15 Gy in 3 fractions, 12 Gy in 3 fractions, 15 Gy in 3 fractions for both hands and additional 21 Gy in 7 fractions only for left hand. OUTCOMES: The tumors shrank after 2 months of radiotherapy and the patient recovered well. Side effects included nail hyperplasia and paronychia. LESSONS: Connections between scald and distant metastasis of malignant tumors in this case needed further investigation. Considering reserving function of the fingers while dealing with metastasis, radiotherapy is recommended rather than surgery.

Patterns and timing of recovery from facial nerve palsy after nerve-sparing parotid surgery: the role of neuromuscular retraining.

OBJECTIVES: Among the complications of parotid surgery, facial palsy is frequent and burdened by high functional and social impact for the patient. There are few data on the efficacy of facial neuromuscular retraining (FNR) in patients with facial palsy after parotid surgery, and no data exist on its impact in timing and extent of recovery. MATERIAL AND METHODS: A retrospective study was conducted on patients undergoing FN sparing parotid surgery and suffering from postoperative facial palsy. Among 400 patients undergoing surgery between July 2016 and May 2023, those with the preservation of the FN and onset of facial palsy were selected. Nerve function was evaluated during 2 years follow up using the House-Brackman (H&Bs) and Sunnybrook scales (SBs). RESULTS: A total of 46 patients undergoing partial or total parotidectomy were included. At discharge 18 patients (39,1%) had IV to VI grade paralysis according to the H&Bs and the mean SBs value was 54. At 2 and 6 months after surgery, the average value of Sunnybrook increased to 76.5 and 95.4 respectively. After 12 months no patients with IV to VI grade paralysis were represent in our cohort. Two years after surgery, only five patients (10.9%) had persistent grade II paralysis according to HBs. CONCLUSIONS: Our study supports the efficacy of FNR in the rehabilitation of facial paralysis after nerve-sparing parotidectomy. The greater functional improvement is achieved within the first 6 months of rehabilitation. A significant improvement is detected still after 18 months, supporting the importance of long rehabilitation for patients without complete recovery after the first year.

Follicular Dendritic Cell Sarcoma of the Parotid Gland: A Case Report and Review of Literature.

Follicular dendritic cell sarcoma of the parotid gland is an extremely rare tumor, with only six cases reported in the literature. A 51-year-old female had a 3.0 cm tumor resected from the right parotid gland. The tumor exhibited solid sheets, whorls, fascicular pattern, and syncytium appearance with an indistinct cell border. The lymphocytic infiltrate was sprinkled throughout the neoplasm, with focal prominent perivascular cuffing. Immunohistochemically, it was positive for follicular dendritic cell markers CD21, CD23, and CD35. We aim to enhance the understanding of this neoplasm and alert pathologists to this rare entity in this region to avoid misdiagnosis.

Nomogram based on immune-inflammatory indicators and age-adjusted charlson comorbidity index score to predict prognosis of postoperative parotid gland carcinoma patients.

BACKGROUND: Parotid gland carcinoma (PGC) is a rare malignant tumor. The purpose of this study was to investigate the role of immune-inflammatory-nutrition indicators and age-adjusted Charlson comorbidity index score (ACCI) of PGC and develop the nomogram model for predicting prognosis. METHOD: All patients diagnosed with PGC in two tertiary hospitals, treated with surgical resection, from March 2012 to June 2018 were obtained. Potential prognostic factors were identified by univariate and multivariate Cox regression analyses. The nomogram models were established based on these identified independent prognostic factors. The performance of the developed prognostic model was estimated by related indexes and plots. RESULT: The study population consisted of 344 patients with PGC who underwent surgical resection, 285 patients without smoking (82.8%), and 225 patients (65.4%) with mucoepidermoid carcinoma, with a median age of 50.0 years. American Joint Committee on Cancer (AJCC) stage (p < 0.001), pathology (p = 0.019), tumor location (p < 0.001), extranodal extension (ENE) (p < 0.001), systemic immune-inflammation index (SII) (p = 0.004), prognostic nutrition index (PNI) (p = 0.003), ACCI (p < 0.001), and Glasgow prognostic Score (GPS) (p = 0.001) were independent indicators for disease free survival (DFS). Additionally, the independent prognostic factors for overall survival (OS) including AJCC stage (p = 0.015), pathology (p = 0.004), tumor location (p < 0.001), perineural invasion (p = 0.009), ENE (p < 0.001), systemic immune-inflammation index (SII) (p = 0.001), PNI (p = 0.001), ACCI (p = 0.003), and GPS (p = 0.033). The nomogram models for predicting DFS and OS in PGC patients were generated based on these independent risk factors. All nomogram models show good discriminative capability with area under curves (AUCs) over 0.8 (DFS 0.802, and OS 0.825, respectively). Decision curve analysis (DCA), integrated discrimination improvement (IDI), and net reclassification index (NRI) show good clinical net benefit of the two nomograms in both training and validation cohorts. Kaplan-Meier survival analyses showed superior discrimination of DFS and OS in the new risk stratification system compared with the AJCC stage system. Finally, postoperative patients with PGC who underwent adjuvant radiotherapy had a better prognosis in the high-, and medium-risk subgroups (p < 0.05), but not for the low-risk subgroup. CONCLUSION: The immune-inflammatory-nutrition indicators and ACCI played an important role in both DFS and OS of PGC patients. Adjuvant radiotherapy had no benefit in the low-risk subgroup for PGC patients who underwent surgical resection. The newly established nomogram models perform well and can provide an individualized prognostic reference, which may be helpful for patients and surgeons in proper follow-up strategies.