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 advanced-stage 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.
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 advanced-stage 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.
Authors: Diane Wenhua Chen; Jan S Lewin; Li Xu; Stephen Y Lai; G Brandon Gunn; Clifton David Fuller; Abdallah S R Mohamed; Aasheesh Kanwar; Erich M Sturgis; Katherine A Hutcheson Journal: Otolaryngol Head Neck Surg Date: 2016-10-03 Impact factor: 3.497
Authors: Matthew E Spector; Janice L Farlow; Catherine T Haring; J Chad Brenner; Andrew C Birkeland Journal: Discov Med Date: 2018-05 Impact factor: 2.970
Authors: Philip J Stephens; Helen R Davies; Yoshitsugu Mitani; Peter Van Loo; Adam Shlien; Patrick S Tarpey; Elli Papaemmanuil; Angela Cheverton; Graham R Bignell; Adam P Butler; John Gamble; Stephen Gamble; Claire Hardy; Jonathan Hinton; Mingming Jia; Alagu Jayakumar; David Jones; Calli Latimer; Stuart McLaren; David J McBride; Andrew Menzies; Laura Mudie; Mark Maddison; Keiran Raine; Serena Nik-Zainal; Sarah O'Meara; Jon W Teague; Ignacio Varela; David C Wedge; Ian Whitmore; Scott M Lippman; Ultan McDermott; Michael R Stratton; Peter J Campbell; Adel K El-Naggar; P Andrew Futreal Journal: J Clin Invest Date: 2013-06-17 Impact factor: 14.808