Daisuke Kawakita1, Takayuki Murase2, Kaori Ueda2,3, Satoshi Kano4, Yuichiro Tada5, Kiyoaki Tsukahara6, Kenji Okami7, Tetsuro Onitsuka8, Yasushi Fujimoto9, Takuma Matoba1, Kazuo Sakurai10, Toru Nagao3, Nobuhiro Hanai11, Ryo Kawata12, Naohito Hato13, Ken-Ichi Nibu14, Makoto Urano15, Ken-Ichi Taguchi16, Masato Nakaguro17, Kimihide Kusafuka18, Hidetaka Yamamoto19, Toshitaka Nagao20, Hiroshi Inagaki21. 1. Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 2. Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-ku, Nagoya, 467-8601, Japan. 3. Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan. 4. Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan. 5. Department of Head and Neck Oncology and Surgery, Mita Hospital, International University of Health and Welfare, Tokyo, Japan. 6. Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan. 7. Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan. 8. Division of Head and Neck Surgery, Shizuoka Cancer Center, Mishima, Japan. 9. Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 10. Department of Otorhinolaryngology, Fujita Health University, Toyoake, Japan. 11. Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 12. Department of and Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Japan. 13. Department of Otolaryngology, Ehime University School of Medicine, Matsuyama, Japan. 14. Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 15. Department of Diagnostic Pathology, School of Medicine, Fujita Health University, Toyoake, Japan. 16. Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan. 17. Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan. 18. Department of Pathology, Shizuoka General Hospital, Shizuoka, Japan. 19. Department of Anatomic Pathology, Graduate of School of Medical Science, Kyushu University, Fukuoka, Japan. 20. Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan. 21. Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-ku, Nagoya, 467-8601, Japan. hinagaki@med.nagoya-cu.ac.jp.
Abstract
BACKGROUND: Owing to the low incidence of adenoid cystic carcinoma (AdCC), reliable survival estimates and prognostic factors remained unclarified. METHODS: In this multi-institutional retrospective analysis, we collected 192 AdCC cases, and investigated the impact of clinicopathological factors on clinical outcomes of the patients. All AdCC cases were of salivary gland origin and were surgically treated with curative intent. Diagnoses of AdCC were validated by a central pathology review by expert pathologists. RESULTS: The 5-year overall survival (OS) and disease-free survival (DFS) rates were 92.5 and 50.0%, respectively. Treatment failure occurred in 89 patients (46%) with the distant failures in 65 (34%). Multivariate analysis indicated that pN2 and a pathologically positive surgical margin were independent prognostic factors for both OS and DFS. Histological grade III was an independent prognostic factor for OS. A primary site in the submandibular gland, pT3/4, pN1, and histological grade II were independent prognostic factors for DFS. Postoperative radiation therapy (PORT) improved the locoregional control (LRC) rate. Prophylactic neck dissection was not associated with a better OS or better LRC among patients with cN0. Facial nerve dissection did not improve clinical outcomes in parotid AdCC cases without facial nerve palsy. CONCLUSIONS: A higher TN classification, a pathologically positive surgical margin, and a higher histological grade were associated with a lower OS. PORT improved LRC rates but neck dissection failed to improve clinical outcomes in patients with cN0. As the distant metastasis was frequent, effective systemic therapy is imperative to improve the survival of AdCC patients.
BACKGROUND: Owing to the low incidence of adenoid cystic carcinoma (AdCC), reliable survival estimates and prognostic factors remained unclarified. METHODS: In this multi-institutional retrospective analysis, we collected 192 AdCC cases, and investigated the impact of clinicopathological factors on clinical outcomes of the patients. All AdCC cases were of salivary gland origin and were surgically treated with curative intent. Diagnoses of AdCC were validated by a central pathology review by expert pathologists. RESULTS: The 5-year overall survival (OS) and disease-free survival (DFS) rates were 92.5 and 50.0%, respectively. Treatment failure occurred in 89 patients (46%) with the distant failures in 65 (34%). Multivariate analysis indicated that pN2 and a pathologically positive surgical margin were independent prognostic factors for both OS and DFS. Histological grade III was an independent prognostic factor for OS. A primary site in the submandibular gland, pT3/4, pN1, and histological grade II were independent prognostic factors for DFS. Postoperative radiation therapy (PORT) improved the locoregional control (LRC) rate. Prophylactic neck dissection was not associated with a better OS or better LRC among patients with cN0. Facial nerve dissection did not improve clinical outcomes in parotid AdCC cases without facial nerve palsy. CONCLUSIONS: A higher TN classification, a pathologically positive surgical margin, and a higher histological grade were associated with a lower OS. PORT improved LRC rates but neck dissection failed to improve clinical outcomes in patients with cN0. As the distant metastasis was frequent, effective systemic therapy is imperative to improve the survival of AdCC patients.
Authors: Michał Żurek; Kamil Jasak; Karolina Jaros; Piotr Daniel; Kazimierz Niemczyk; Anna Rzepakowska Journal: Int J Environ Res Public Health Date: 2022-08-18 Impact factor: 4.614