Adenoid Cystic Carcinoma of the Head and Neck: Epidemiology and Predictors of Prognosis

Abstract

Objectives:The biologic behavior of the adenoid cystic carcinoma (ACC) and the factors predicting outcome for these tumors are still poorly understood. Our objective is to analyze the predicting factors and the value of different treatment possibilities, since none sole treatment has been standardized. Methods: A retrospective analysis of the epidemiologic, clinical and histologic aspects of ACC, as well as treatment options and other prognostic factors of all the cases of ACC of the head and neck treated at this Institution were analyzed. From 1974 until 2011, 152 patients were diagnosed with ACC and treated at the Portuguese Institute of Oncology (Porto Centre). Main outcome measures: overall survival, local recurrence and distant metastasis were calculated by the Kaplan-Meier method. Factors predictive of outcome were identified by univariate and multivariate analysis. Results: The mean age at diagnosis was 55.8 years (range, 19 -83 years). Incidence was higher in the female population, with a female to male ratio of 1.7:1 respectively. The primary tumor location was hard palate and submandibular region in 56 cases, 28 in each location (24.6%), parotid gland (17 cases, 14.9%) and oral cavity excluding palate (16 cases, 14%).Distributions according to T stage were: T1 (29.8%); T2 (30.7%); T3 (17.5%); T4 (22%). The overall 1-year, 5-year and 10-year survival for all patients were 94.6%, 60.5%, 41.6%, respectively. Conclusions: Univariate survival analysis revealed that age older than 60 years (p = 0.002), solid histologic subtype (p = 0.042), advanced clinical stage (p < 0.001) and the presence of perineural invasion (p = 0.036) were correlated with a poor survival. Multivariate analysis confirmed that age and advanced clinical stage were worst independent predicators of overall survival as well as perineural invasion for local recurrence and distant metastasis. In our analysis, radiotherapy did not have a relevant impact on survival, except in cases of solid histologic subtype. To analyze distant metastatic capacity, long term follow-up was necessary, since distant metastasis way occurs even after 10 years, which has the case with 4 patients.

Adenoid Cystic Carcinoma of Head and Neck: Clinical Predictors of Outcome from a Canadian Centre

“…In the present study, advanced age (that is >60 years) did not affect dfs, implying that age alone does not modify the natural history of acc. The parotid and other salivary glands, followed by the oro-nasopharyngeal spaces, were the most common sites of origin, consistent with the literature 11,28,29 .…”

Contemporary diagnostic and therapeutic possibilities in patients with adenoid cystic carcinoma of the head and neck

“…Locations outside the large salivary glands include the salivary glands of the tongue, paranasal sinuses, the palate, nasopharynx, or lacrimal glands. Adenoid cystic carcinomas extremely rarely develop in the secretory glands such as the bronchial tree, oesophagus, mammary glands, lungs, prostate, cervix, or Bartholin's glands [2][3][4][5][6][7][8][9]. ACCs in head and neck organs can occur at any age.…”

“…Originally, ACCs were called "cylindroma" due to their characteristic pathomorphological picture, consisting of cylindrical epithelial cells with the presence of hyaline stroma. ACC cell nuclei are hyperchromatic and contain a small amount of transparent or eosinophilic cytoplasm [1,3,4,12,13].…”

“…It is believed that the expression of c-KIT and vascular endothelial growth factor receptors (VEGFR) may correlate with an aggressive course of the cancer and unfavourable prognosis. It cannot be excluded that the interaction between Beclin-1 and p53 and Bcl-2 may play a role in the pathogenesis of cancer and that P53 expression is particularly pronounced during disease progression [3,4,6,12,[16][17][18].…”

“…The incidence of metastases has been shown to be dependent on the histopathological subtype and is 47.7%, 29.9%, and 27.3% in solid, cribriform, and tubular subtypes, respectively (16-35% on average) [34]. Other risk factors associated with unfavourable survival prognosis include the stage at diagnosis, advanced age, and lack of radical resection [4].…”