Disparities in Postoperative Therapy for Salivary Gland Adenoid Cystic Carcinomas

Cassidy, Richard J.; Switchenko, Jeffrey M.; El‐Deiry, Mark W.; Belcher, Ryan; Zhong, Jim; Steuer, Conor E.; Saba, Nabil F.; McDonald, Mark W.; Yu, David S.; Gillespie, Theresa W.; Beitler, Jonathan J.

doi:10.1002/lary.27302

Cited by 14 publications

(27 citation statements)

References 37 publications

(110 reference statements)

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“…Prior studies evaluating cohorts of parotid cancer or mixed major and minor salivary malignancies reported decreased OS with positive margins. 22-25,29,47 However, this was not confirmed in studies restricted to submandibular carcinoma, likely due to low power. Cohen et al 20 evaluated 22 patients with submandibular adenoid cystic carcinoma and found that OS did not differ by margin status.…”

Section: Discussionmentioning

confidence: 95%

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

Benchetrit

Morse

Judson

et al. 2019

Otolaryngol.--head neck surg.

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Objectives Identify positive margin rate in a national cohort of patients with submandibular carcinoma, identify predictors of positive margins, and associate margins with overall survival. Study Design Retrospective cohort. Setting Commission on Cancer–accredited hospitals. Subjects and Methods We included patients in the National Cancer Database from 2004 to 2014 who were diagnosed with submandibular carcinoma and underwent primary surgical resection. We determined the rate of positive surgical margins and associated patient, tumor, and treatment factors with positive margins via univariable and multivariable logistic regression analysis. We associated margin status with overall survival by Kaplan-Meier curve and Cox proportional hazards regression. Results We identified 1150 patients with submandibular malignancy undergoing surgical resection. Positive margin rate was 41.0%. Increased odds of positive margins were seen in patients with advanced T stage (vs T1, T3: odds ratio [OR] = 3.04, P < .001; T4a: OR = 2.89, P < .001), adenoid cystic carcinoma histology (OR = 1.54, P = .020), and those treated at nonacademic facilities (OR = 1.41, P = .008). Patients who underwent a preoperative diagnostic biopsy had decreased odds of positive margins (OR = 0.72, P = .014). Positive margins were associated with reduced overall survival (58% vs 69% 5-year overall survival, P < .001; hazard ratio = 1.49, P = .001) when controlling for patient, tumor, and management factors. Conclusions The national positive margin rate of submandibular carcinoma is 41.0%. Preoperative biopsy and treatment at academic institutions independently decreased the risk of positive margins, and positive margins were independently associated with diminished overall survival. Positive margin rate for submandibular carcinoma may be considered a benchmark for quality of care.

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Section: Discussionmentioning

confidence: 95%

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

Benchetrit

Morse

Judson

et al. 2019

Otolaryngol.--head neck surg.

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“…The adenoid cystic carcinoma is a severe disease, which is featured by the resistance to various treatments such as chemotherapy (i.e., see Visa et al 2010; Caballero et al 2013; Cassidy et al 2018) including metronomic therapy. Given this fact we decided to investigate the transcriptional profiles of ACC samples and compare them with transcript profiles of normal tissue to identify the molecular features which could be helpful in the explanation of such severe chemoresistancy of ACC.…”

Section: Resultsmentioning

confidence: 99%

“…Surgery with postoperative radiotherapy remains the most effective therapeutic modality in patients with early-stage head and neck adenoid cystic carcinoma (Coca-Pelaz et al 2015 ). In the case when surgery is impossible, the radiotherapy has been used and some attempts with chemotherapy including metronomic therapy; however, the outcome of such treatments is not satisfactory (Visa et al 2010 ; Caballero et al 2013 ; Ko et al 2016 ; Cassidy et al 2018 ). As there is no efficient therapy for the advanced stage of the adenoid cystic carcinoma there was an urgent need to investigate molecular basis of this type of cancer.…”

Section: Discussionmentioning

confidence: 99%

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Advanced adenoid cystic carcinoma (ACC) is featured by SWI/SNF chromatin remodeling complex aberrations

Jagielska

Sarnowska

Rusetska

et al. 2018

J Cancer Res Clin Oncol

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PurposeAdenoid cystic carcinoma (ACC) is a rare neurotropic cancer with slow progression occurring in salivary glands and less frequently in other body parts. ACC is featured by hyperchromatic nuclei and various mutations in genes encoding chromatin-related machineries. The ACC treatment is mainly limited to the radical surgery and radiotherapy while the chemotherapy remains ineffective. As the knowledge about molecular basis of ACC development is limited, we investigated here the molecular features of this disease.Patients and methodsThis study included 50 patients with ACC. Transcript profiling of available ACC samples vs normal salivary gland tissue, quantitative real-time PCR (qRT-PCR) transcript level measurements and the immunohistochemistry (IHC) for SWI/SNF chromatin remodeling complex (CRC) subunits and androgen receptor on surgery-derived paraffin-embedded samples were performed.ResultsTranscriptomic study followed by Gene Ontology classification indicated alteration of chromatin-related processes, including downregulated transcript levels of main SWI/SNF CRC subunits and elevated expression of BRM ATPase-coding SMARCA2 gene in ACC. Subsequent IHC indicated broad accumulation of BRM ATPase and several SWI/SNF subunits, suggesting affected control of their protein level in ACC. The IHC revealed ectopic, heterogeneous expression of androgen receptor (AR) in some ACC cells.ConclusionsOur study indicated that ACC features aberrant expression of genes controlling chromatin status and structure. We found that the balance between SWI/SNF classes is moved towards the BRM ATPase-containing complex in ACC. As BRM is known to be involved in chemoresistance in cancer cells, this observation may be the likely explanation for ACC chemoresistance.Electronic supplementary materialThe online version of this article (10.1007/s00432-018-2783-5) contains supplementary material, which is available to authorized users.

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“… 10 – 11 In contrast, some studies have found that no significant association exists between postoperative radiotherapy and OS. 9 , 12 At present, there are still limited data to guide doctors in choosing treatment during the postoperative period, and the clinical significance of adjuvant radiotherapy is still worthy of exploration. The present study is intended to examine the significance of adjuvant radiotherapy for the survival of ACC patients undergoing radical resection.…”

Section: Introductionmentioning

confidence: 99%

Analysis of postoperative radiotherapy for non-metastatic head and neck adenoid cystic carcinoma based on SEER data

Du¹,

Zeng²

2022

J Int Med Res

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Objective The postoperative role of adjuvant radiotherapy in non-metastatic head and neck adenoid cystic carcinoma (ACC) remains controversial. We analyzed adjuvant radiotherapy’s effect on surgical patient survival. Methods Patients diagnosed with ACC from 2004 to 2015 in the Surveillance, Epidemiology, and End Results database were analyzed. The overall survival (OS) and disease-specific survival (DSS) of patients after adjuvant radiotherapy were assessed using the Kaplan–Meier and multivariate Cox methods. Propensity score matching (PSM) was performed to adjust confounders between patients with or without adjuvant radiotherapy; a forest plot was generated by subgroup analysis. Results The study included 742 patients. In the PSM cohort, adjuvant radiotherapy did not improve OS or DSS. Radiotherapy was not a protective factor for OS or DSS in the univariate and multivariate Cox proportional hazard models. In the subgroup analysis, postoperative radiotherapy improved the OS of female and N1-stage patients and those with oropharyngeal tumors or over 79 years and the DSS of N1-stage patients. Conclusions Postoperative radiotherapy showed different benefits in ACC patients, and postoperative radiotherapy recommendations should be individualized. Female and N1-stage ACC patients and those with oropharyngeal tumors or patients over 79 years without distant metastases postoperatively could benefit from adjuvant radiotherapy.

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Disparities in Postoperative Therapy for Salivary Gland Adenoid Cystic Carcinomas

Abstract: 2c. Laryngoscope, 2018.

Cited by 14 publications

References 37 publications

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

Advanced adenoid cystic carcinoma (ACC) is featured by SWI/SNF chromatin remodeling complex aberrations

Analysis of postoperative radiotherapy for non-metastatic head and neck adenoid cystic carcinoma based on SEER data

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