Adenoid Cystic Carcinoma of Head and Neck: Clinical Predictors of Outcome from a Canadian Centre

Abstract

Objectives Adenoid cystic carcinoma (acc) is often treated with surgery, with or without adjuvant radiation therapy (rt). We evaluated disease characteristics, treatments, and potentially prognostic variables in patients with acc.Methods Our retrospective analysis considered consecutive cases of acc presenting at a tertiary care hospital between 2000 and 2014. Factors predictive of overall survival (os) and disease-free survival (dfs) were identified by univariate analysis. ResultsThe 60 patients analyzed had a mean age of 58 years (range: 22-88 years), with a 2:1 female:male ratio. Tumour locations included the major salivary glands (40% parotid, 17% submandibular and sublingual), the oro-nasopharyngeal cavity (27%), and other locations (16%). Of the 60 patients, 35 (58%) received surgery with adjuvant rt; 12 (20%), rt only; 13 (22%), surgery only. Of 18 patients (30%) who experienced a recurrence within 5 years, 3 (5%) developed local recurrence only, and the remaining 15 (25%), distant metastasis. The 5-year os and dfs were 64.5% [95% confidence interval (ci): 45.9% to 78.1%] and 46.2% (95% ci: 29.7% to 61.2%) respectively. In patients without recurrence, 5-year os was 77% (95% ci: 52.8% to 89.9%), and in patients with recurrence, it was 42.7% (95% ci: 15.8% to 67.6%). Patients treated with rt only had a 5-year os of 9.2%. Predictors of 5-year dfs were TNM stage, T stage, nodal status, treatment received, and margin status; age, nodal status, treatment received, and margin status predicted 5-year os.Conclusions Despite surgery and rt, one third of patients with acc experience distant recurrence. Patients whose tumours are not amenable to surgery have a poor prognosis, indicating a need for alternative approaches to improve outcomes.

SALIVARY GLANDS; CLINICAL & HISTOPATHOLOGICAL SPECTRUM OF ADENOID CYSTIC CARCINOMA & MUCOEPIDERMOID CARCINOMAS REPORTED AT TERTIARY CARE HOSPITALS IN LAHORE

“…Cribriform pattern was the most frequently encountered pattern in the present which is again consistent with the studies conducted worldwide. 20 Perineural invasion (p=0.746) was seen in 7(35%) cases of AdCC in the current study which is in concurrence with the results of other studies 10 Table- dictates the treatment protocol for the patients of MEC. 6,11,14 The study conducted by Nance 19 Lymph node metastasis were found to be significantly associated with the grade of tumour (p=0.01) being negative in all grade I tumours and positive in 4(44.5%) and 5(55.5%) cases of intermediate and high grade MEC respectively.…”

“…1,12 In contrast, other studies have reported major salivary glands to be more common site for AdCC than minor salivary glands. 10,13 For MEC, the current study is in harmony with other studies in that major salivary glands, most commonly parotid gland, are more commonly affected than minor salivary glands.…”

“…A study conducted in Turkey has reported mean age for AdCC and MEC to be 50.9 years and 51.6 years respectively which is quite higher than the current study. 1 Other studies conducted in Canada 10 and USA 11 study have reported 58±15 years and 48.2 years as mean age for ACC patients which is again quite high than the current study. Zaman 12 in Pakistan and de Oliveira 13 in Brazil have reported 36.33 years and 38.5 years respectively as the mean age of MEC which is closer to the current study.…”

“…10 On the other hand, Zaman 12 have reported equal gender distribution for AdCC. Studies conducted in China 14 & USA 15 have reported female predominance in MEC in contrast to the current study.…”

Parotid adenoid cystic carcinoma: Retrospective single institute analysis

“…For instance, the American Joint Committee on Cancer (AJCC) TNM staging system [9], according to the T-status, the N-status, and the M-status, does not add anything to single cancer patient biology, because it does not enclose more specific variables such perineurial invasion or histologic grading, tumor site, and other patients characteristics i.e. : age, gender, smoking status and/or alcohol consumption, type of surgery performed with/without adjuvant radiotherapy or chemotherapy, late distant metastasis onset [10,11]. Only one multi center international study [12] has recently published the first nomogram analysis with the aim to predict single ACC patient prognosis using different clinical and pathological parameters never established before.…”