Prognosis and risk factors for early‐stage adenoid cystic carcinoma of the major salivary glands

Abstract

BACKGROUND: Adenoid cystic carcinoma (ACC) is characterized by slow growth, frequent local recurrences, and distant metastasis (DM). However, these findings frequently are reported in patients with advancedstage tumors, but the outcomes of early-stage tumors are poorly defined. We sought to evaluate the risk factors for the development of DM in early-stage ACC. METHODS: We retrospectively reviewed the charts of 60 patients who were diagnosed with clinical early-stage (T1-2/N0) ACC to determine the risk factors for development of DM and survival of these patients. RESULTS: DM was detected in 12 (20%) of the patients, with a median latency of 31.5 months after diagnosis. Univariate analysis revealed that DM was associated with age !45 years, pathologically positive lymph nodes, extracapsular spread (ECS) from lymph nodes, high-grade histology, and solid tumor subtype. Multivariate analysis revealed solid tumor subtype and ECS to be significantly associated with DM. Disease-specific survival rates at 5 and 10 years for patients with DM were 80% and 40%, respectively, and were both 100% for patients without DM. CONCLUSION: Although the majority of patients with clinical early-stage ACC of the major salivary glands have favorable prognosis, a significant percentage of patients will develop DM. Solid tumor subtype and nodal ECS were independent predictors of DM in early-stage ACC of major salivary glands. Other clinical and pathological variables may also contribute. These subgroups had poor overall and disease-specific survival. Such patients should be observed closely for the development of DM. Systemic therapy should be considered at the time of diagnosis.

Clinicopathological Review and Survival Characteristics of Adenoid Cystic Carcinoma

“…Consistent with studies by Gomez et al [14,] and Agnes Oplatek [16] who demonstrated decreased survival in patients with cervical nodal metastasis, our data showed a decrease in survival, too. Whereas isolated lymph node involvement without distant metastasis may not have significantly altered survival in some studies, [17] lymph node involvement is a risk factor for subsequent distant metastasis [9]. The findings of the present study are concordant with those from other study [16] confirming the important impact of tumor site at diagnosis.ACC is wellknown for its indolent growth but common recurrence.…”

Whole exome sequencing of adenoid cystic carcinoma

“…The case series consisted of 19 that were scored as positive for MYB activation and comprised a roughly equal mixture of cribriform and predominantly solid histological forms of ACC (Supplemental Table 1). The latter are associated with increased risk of local-regional relapse, distant metastases, and poorer overall survival (4).…”

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

“…Although hormones or other sex-dependent biologic factors might explain a greater female:male ratio, whether the same factors affect disease behaviour or outcomes is unknown. Likewise, some-but not all-studies showed an association between advanced age and more advanced disease stage or dfs 9,25 . In the present study, advanced age (that is >60 years) did not affect dfs, implying that age alone does not modify the natural history of acc.…”

“…Surgery, the traditional mainstay of treatment for localized acc, results in improved survival [5][6][7][8] nodes 4,[9][10][11] . In cases in which surgery is not possible, radiotherapy alone has been used, but with inferior results 8,[12][13][14][15][16][17][18] .…”