Analysis of failure in patients with adenoid cystic carcinoma of the head and neck. An international collaborative study

Abstract

The clinical course of ACC is slow but persistent. Paranasal sinus origin is associated with the lowest distant metastases rate but with the poorest outcome. These prognostic estimates should be considered when tailoring treatment for patients with ACC.

Higher positive lymph node ratio indicates poorer distant metastasis–free survival in adenoid cystic carcinoma patients with nodal involvement

“…ACC cells in LN may extend to the membrane structure with a result of adjacent soft tissue involvement. In the study of Amit et al (2014b), LN extracapsular spread was statistically correlated with DM rate in univariate analysis but not in multivariate analysis, which was in accordance with our findings concerning DM rate.…”

“…However, this rate was higher than the local recurrence ratio of 3.3% in the study of early stage ACC of the major salivary gland (Bhayani et al, 2012). The overall DM rate was 36.1% in our patients with predominant site of lung, and it was much higher than the average incidence of about 15%e20% as demonstrated by previous works (Li et al, 2011;Agarwal et al, 2008;Van et al, 2013;Amit et al, 2014b;Bianchi et al, 2008;Maciejewski et al, 2002). ACC patients with LN involvement had higher DM rates (40%) than those without LN invasion (27%) (Amit et al, 2014a).…”

“…LN involvement was not so common in ACC as compared with squamous cell carcinoma of the head and neck (Balamucki et al, 2012). Several works have identified the influence of LN status on ACC outcomes, which indicated that positive LN was related to worse prognosis (Bhayani et al, 2012; Amit et al, 2014a;Min et al, 2012;Agarwal et al, 2008;Van et al, 2013;Amit et al, 2014b). The estimation of LN status was judged only as positive or negative in these studies, and there was no systemic evaluation concerning whether the number of positive LN and positive ratio had a predictive role in the ACC outcomes.…”

“…The higher DM rate and average survival rate indicated that neck metastasis may not prompt the death of patients, which may be, to some extent, related with the biological behavior of long-time survival with tumor, confirming the finding of Bianchi et al (2008) that 50% of the ACC patients with DM were still alive at the end of follow-up. Usually, the factor of LN metastasis was analyzed in a pattern of negative or positive, and there was no doubt that positive LN confers worse outcomes than negative LN (Agarwal et al, 2008;Van et al, 2013;Amit et al, 2014b;da Cruz et al, 2006;Bianchi et al, 2008). This was the first ACC analysis in which the number of positive LN, positive LN ratio, and its distribution were taken into consideration.…”

Clinicopathological Review and Survival Characteristics of Adenoid Cystic Carcinoma

“…Hence, it is classified as ''high risk'' by the World Health Organization [10]. The overall survival of the present study was approximately the same as, much better or less than those reported in the other studies [7,[11][12][13][14]. The differences between their data and the present study were evaluated in terms of the following: (1) the outcome for patients with ACC is site dependent [15].…”