Moran Amit1,2, Shorook Na'ara1,2, Leonor Trejo-Leider3, Naomi Ramer4, David Burstein4, Ma Yue5, Brett Miles5, Xinjie Yang6, Delin Lei6, Kristine Bjoerndal7, Christian Godballe7, Thomas Mücke8, Klaus-Dietrich Wolff8, André M Eckardt9, Chiara Copelli10, Enrico Sesenna10, Snehal Patel11, Ian Ganly11, Ziv Gil1,2. 1. The Head and Neck Center, Department of Otolaryngology - Head and Neck Surgery, Rambam Medical Center, Haifa, Israel. 2. The Clinical Research Institute at Rambam, Rambam Medical Center, Rappaport Faculty of Medicine and Research Institute, The Technion, Israel Institute of Technology, Haifa, Israel. 3. Department of Pathology, Tel Aviv Medical Center, Tel Aviv, Israel. 4. Department of Pathology, The Mount Sinai School of Medicine, New York, New York. 5. Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York. 6. Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China. 7. Department of Otolaryngology, Head and Neck Surgery, Odense University Hospital Denmark, Denmark, Germany. 8. Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany. 9. Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany. 10. Department of Maxillofacial Surgery, University Hospital of Parma, Parma, Italy. 11. Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Abstract
BACKGROUND: The mainstay of treatment in adenoid cystic carcinoma (ACC) of the head and neck is surgical resection with negative margins. The purpose of this study was to define the margin status that associates with survival outcomes of ACC of the head and neck. METHODS: We conducted univariate and multivariate analyses of international data. RESULTS: Data of 507 patients with ACC of the head and neck were analyzed; negative margins defined as ≥5 mm were detected in 253 patients (50%). On multivariate analysis, the hazard ratios (HRs) of positive margin status were 2.68 (95% confidence interval [CI], 1.2-6.2; p = .04) and 2.63 (95% CI, 1.1-6.3; p = .03) for overall survival (OS) and disease-specific survival (DSS), respectively. Close margins had no significant impact on outcome, with HRs of 1.1 (95% CI, 0.4-3.0; p = .12) and 1.07 (95% CI, 0.3-3.4; p = .23) for OS and DSS, respectively, relative with negative margins. CONCLUSION: In head and neck ACC, positive margins are associated with the worst outcome. Negative or close margins are associated with improved outcome, regardless of the distance from the tumor.
BACKGROUND: The mainstay of treatment in adenoid cystic carcinoma (ACC) of the head and neck is surgical resection with negative margins. The purpose of this study was to define the margin status that associates with survival outcomes of ACC of the head and neck. METHODS: We conducted univariate and multivariate analyses of international data. RESULTS: Data of 507 patients with ACC of the head and neck were analyzed; negative margins defined as ≥5 mm were detected in 253 patients (50%). On multivariate analysis, the hazard ratios (HRs) of positive margin status were 2.68 (95% confidence interval [CI], 1.2-6.2; p = .04) and 2.63 (95% CI, 1.1-6.3; p = .03) for overall survival (OS) and disease-specific survival (DSS), respectively. Close margins had no significant impact on outcome, with HRs of 1.1 (95% CI, 0.4-3.0; p = .12) and 1.07 (95% CI, 0.3-3.4; p = .23) for OS and DSS, respectively, relative with negative margins. CONCLUSION: In head and neck ACC, positive margins are associated with the worst outcome. Negative or close margins are associated with improved outcome, regardless of the distance from the tumor.
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