Patterns of recurrence and survival of head and neck adenoid cystic carcinoma after definitive resection

Abstract

Objectives/Hypothesis: To determine factors impacting recurrence and long-term survival of adenoid cystic carcinoma (ACC) of the head and neck after definitive resection.Study Design: Retrospective cohort study at an academic tertiary care hospital.Methods: Patients with ACC of the head and neck treated at our institution were reviewed. Those not receiving surgery, or with metastatic disease were excluded. Clinicopathological data on each patient was collected.Results: Of 113 patients identified with ACC, 99 were studied. The overall median survival for the cohort was 71 months (mean AE standard deviation, 94 AE 79 months). American Joint Committee on Cancer (AJCC) tumor stage and N stage were independent predictors of survival on multivariate analysis. Mean overall survival (P ¼ .001) and time to recurrence (P ¼ .006) were lower for patients with cervical lymph node positive disease (Nþ). Tumors in major salivary glands were associated with longer survival (P ¼ .027). The overall recurrence rate was 53%, with a mean time to recurrence of 63 AE 64 months. The presence of lymphovascular invasion predicted recurrence on multivariate analysis (P ¼ .002), with advanced tumor stage predicting early ( 36 months) recurrence (P ¼ .013). Among the 57 patients who received adjuvant radiation therapy, there was no difference in survival, rate of recurrence, or time to recurrence, when compared to patients treated with surgery alone.Conclusions: Clinicopathological variables including AJCC tumor stage, tumor site, presence of Nþ disease, and lymphovascular invasion may be used as prognostic factors in predicting survival and recurrence after a definitive resection of ACC of the head and neck.

Adenoid cystic carcinoma: A review of recent advances, molecular targets, and clinical trials

“…Recent data also suggests intraneural, rather than perineural, invasion has a larger impact on survival in head and neck ACC 41. Other parameters that correlate with local recurrence after surgery are age, nonsalivary or minor salivary gland primary, T classification, tumor grade, lymphovascular invasion, and positive surgical margins 5, 11, 38, 42, 43…”

“…Although postoperative radiation seems to improve local control rates, the impact on ACC‐specific survival is not clear 43, 50, 51. Evaluation of survival is confounded by the requirement for long‐term follow‐up as one half of recurrences manifest after 5 years.…”

Salivary gland adenoid cystic carcinoma with cervical lymph node metastasis: a preliminary study of 62 cases

“…Adenoid cystic carcinoma (ACC) is an infrequent malignant neoplasm that originates most commonly in the major and minor salivary glands of the head and neck region, and represents approximately 1-2% of all malignant neoplasms of the head and neck. [1][2][3] Sites other than the head and neck region can also be involved, including the breast, prostate and cuticulum. [4][5][6] As an epithelial malignant tumour, ACC is characterized by infiltrative growth and perineural spread, which results in a high rate of recurrence despite aggressive surgical resection.…”

Clinicopathological features of salivary and non-salivary adenoid cystic carcinomas

“…Nascimento et al excluded ACC of the ear canal, lacrimal glands, larynx, esophagus, and trachea from minor salivary ACC, while others included one or more of them in minor salivary ACC. 10,16,11,19 The present authors used the same definition of minor salivary gland ACC as Nascimento et al, 16 and further termed ACC from other secretary glands beyond major or minor salivary glands in the head and neck region as nonsalivary ACC. In this study, minor salivary ACC had inferior prognosis (log-rank test, EFS, P = 0.02; OS, P = 0.014) than major salivary ACC, compatible with that proposed by Nascimento et al.…”

“…Khan et al reported that sinonasal ACC had worse outcomes than major salivary gland ACC, and Oplatek et al suggested that major salivary gland ACC had better outcomes than minor salivary gland ACC. 10,16,19 The definition of minor salivary gland ACC is inconsistent. Nascimento et al excluded ACC of the ear canal, lacrimal glands, larynx, esophagus, and trachea from minor salivary ACC, while others included one or more of them in minor salivary ACC.…”