Long-term treatment outcomes and prognostic features in adenoid cystic carcinoma of the head and neck

Abstract

Purpose: The aim of this study was to identify independent predictors of outcome and to characterize the patterns of failure in a long-term, single-institution experience with the management of adenoid cystic carcinoma (ACC) of the head and neck using survival analyses. Patients and methods: We investigated prognostic factors, such as gender, age, primary tumor site, TNM stage, treatment modalities, perineural invasion, metastases, surgical margins, histological grade, cervical lymph node metastasis, and postoperative RT spread through 86 cases of ACC diagnosed by Seoul National University Dental Hospital (SNUDH) from 1984 to 2013. The overall survival and disease-free survival were evaluated. Survival rates were predicted and Kaplan-Meier's survival curves were generated for each factor. Cox proportional hazard models were used for multivariate survival analysis. Results: Survival analysis shows that overall survival (OS) at 5 years, 10 years, and 20 years was 75%, 55%, and 41%, respectively. Disease-free survival (DFS) at 5 years, 10 years, and 20 years was 58%, 44%, and 28%, respectively. Univariate analysis revealed that age, primary tumor site, histological subtype, clinical stage, cervical lymph node metastasis, and presence of distant metastasis were significant predictors while perineural invasion, margin involvement, and gender did not demonstrate statistical difference between the treatment groups. Our multivariate analysis revealed that advanced clinical stage (stages III and IV), distant metastasis, and age over 60 years were independent significant prognostic factors. Conclusions: Recurrence and metastasis were the main cause of treatment failure of ACC in head and neck. T stage, age, primary tumor site, histologic type, cervical lymph node metastasis, and distant metastasis were the independent prognostic factors of ACC in head and neck. Radical surgery and reasonably postoperative radiotherapy were the main treatment strategy. (C) 2014 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.(star)