Clinical prognostic factors of salivary adenoid cystic carcinoma: A single-center analysis of 61 patients

https://doi.org/10.1016/j.jcms.2017.08.004Get rights and content

Abstract

Purpose

Adenoid cystic carcinomas are rare malignant tumors of the salivary glands. They are characterized by a high rate of local recurrence, late distant metastasis and a poor disease-free survival. In this study, we analyzed a series of 61 patients who were all treated at the University of Göttingen over a period of 21.0 years.

Materials and methods

In all 61 patients with salivary adenoid cystic carcinoma, clinical data, demographic data, risk factors, tumor location, tumor stage, status of surgical margin, surgical treatment, postoperative radiotherapy and follow-up interval were assessed.

Results

The overall survival (OS) and the disease-free survival (DFS) of patients who underwent surgery and those who underwent combined surgery with radiotherapy showed no significant differences. Neither did the T-stage (T1/T2 vs. T3/T4) show significant differences in OS and DFS. Only the status of the surgical margin was significantly associated with a longer OS and a longer DFS.

Conclusion

The present results confirm that the radical surgical resection with clear tumor-free margins is the most important predictor for a longer survival. Adjuvant radiotherapy should be discussed from case to case, but should not be seen as an absolute prognostic factor for OS.

Introduction

Adenoid cystic carcinomas (ACCs) of the head and neck are rare malignant tumors and account for about 10% of all malignant tumors of the salivary glands (Bradley, 2004). They are located both in the major salivary glands (parotid, submandibular and sublingual salivary gland) and in the small salivary glands all over the upper aerodigestive tract (Bjørndal et al., 2011). They are clinically characterized by slow progressive growth, followed by pain due to the propensity for perineural invasion. Moreover, ACCs tend to be associated with multiple local recurrences as well as late distance metastasis, especially to lung, bone and liver (Kokemueller et al., 2004).

ACCs occur in all age groups, with a higher frequency in middle-aged and older patients (Nascimento et al., 1986). The common established therapy is radical surgery and, depending on the status of the surgical margin and the histopathology results, adjuvant postoperative radiotherapy (Coca-Pelaz et al., 2015). Due to the perineural invasion and the anatomical variability, it is surgically challenging to achieve tumor-free margins.

Because of the occurrence of late recurrences and distant metastasis, the long-term prognosis for ACC is rather poor (Lloyd et al., 2011). In the literature, various survival rates have been reported, mainly due to the relative rarity of ACC patients and the follow-up over many years. The objective of this study was to analyze the survival and prognostic factors in a group of 61 patients treated with ACC at the University of Göttingen, Germany, between 1995 and 2016.

Section snippets

Materials and methods

In this study, we analyzed 68 patients with an ACC, covering the years 1995–2016. Medical charts were reviewed and the following data were collected: gender, age, type of salivary gland, tumor stage, risk factors, operation modalities, surgical margin, postoperative radiotherapy, local and distant recurrence, and follow-up time. Seven patients were excluded because of missing follow-up data, and the remaining 61 patients were included in the retrospective analysis.

The type of surgical procedure

Results

The median age of the study population was 56.4 years (range 28–84 years). Of the patients, 34 were female (55.7%) and 27 were male (44.3%). A total of 46 cases (75.4%) involved the minor salivary glands, with the most common occurrence in the oral cavity and the nasopharynx. Eighteen patients (29.5%) were regular smokers (mean of 21.7 pack-years) and two patients had chronical alcohol abuse. Table 1 provides the demographic, tumor and treatment data. The most affected major salivary gland was

Discussion

There was a female predominance within our group (F:M ratio 1.26:1), which was in agreement with previous studies in European countries (Ciccolallo et al., 2009). In our group, the mean age of occurrence was 56.4 years, ranging from 28 to 84 years. This was consistent with other reports (Spiro et al., 1974, Bjørndal et al., 2011). Regarding the primary tumor site, there were all anatomical locations represented. Most cases were located in the minor salivary glands (75.4%), especially in the

Conclusion

The present results confirm that radical surgical resection with clear negative margins is the most important predictor for survival. Adjuvant radiotherapy should be discussed from case to case, but should not be taken as an absolute therapeutic measure.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Funding

This work was supported by the Department of Oral & Maxillofacial Surgery, the Department of Otolaryngology-Head and Neck Surgery and the Department of Pathology, University of Göttingen, Germany.

Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent

For this type of study, formal consent was not required.

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