Incidence of cervical lymph node metastasis and its association with outcomes in patients with adenoid cystic carcinoma. An international collaborative study

Abstract

Background The patterns of regional metastasis in adenoid cystic carcinoma (ACC) of the head and neck and its association with outcome is not established. Methods We conducted a retrospective multicentered multivariate analysis of 270 patients who underwent neck dissection. Results The incidence rate of neck metastases was 29%. The rate observed in the oral cavity is 37%, and in the major salivary glands is 19% (p = .001). The rate of occult nodal metastases was 17%. Overall 5-year survival rates were 44% in patients undergoing therapeutic neck dissections, and 65% and 73% among those undergoing elective neck dissections, with and without nodal metastases, respectively (p = .017). Multivariate analysis revealed that the primary site, nodal classification, and margin status were independent predictors of survival. Conclusion Our findings support the consideration of elective neck treatment in patients with ACC of the oral cavity.

Regulation of β-Catenin Phosphorylation by PR55β in Adenoid Cystic Carcinoma

“…For head and neck AdCC, the age-adjusted incidence rate is 4.5 cases per 100,000 individuals and exhibits a slight female predominance (1). The risks for delayed recurrence and metastasis in other organs are higher in AdCC than in other oral cancers, such as squamous cell carcinoma (SCC), because of the propensity of AdCC to invade neighbouring tissues and migrate into blood vessels (2,3). Despite the fact that hundreds of malignant AdCC tumors have been characterized at the molecular level, the underlying regulatory mechanisms of this cancer type remain unclear.…”

Molecular features of adenoid cystic carcinoma with an emphasis on microRNAexpression

“…However, the reported low incidence of occult lymph node metastases has made management of the neck in ACC patients without detectable nodal involvement a matter of controversy (8). While high-grade transformation makes neck dissection mandatory due to a high rate of nodal involvement, recent international collaborations have identified occult lymph node metastases in 17% of clinically node-negative patients, with the highest frequencies found in ACC of the oral cavity (22%) and the lowest in the major salivary glands (12%) (11,89). Importantly, nodal stage was shown to be an independent prognostic factor for overall and disease-specific survival (89).…”

“…In head and neck squamous cell carcinoma, the rationale for elective neck dissection in clinically node-negative patients is justified in case of a > 15% risk of occult lymph node metastases (90,91). Hence, the recommendation of selective neck dissection of levels I-III in clinically node-negative patients, especially if the tumor is located to the oral cavity, now seems justified for therapeutic and staging purposes (2,89,92).…”

“…While high-grade transformation makes neck dissection mandatory due to a high rate of nodal involvement, recent international collaborations have identified occult lymph node metastases in 17% of clinically node-negative patients, with the highest frequencies found in ACC of the oral cavity (22%) and the lowest in the major salivary glands (12%) (11,89). Importantly, nodal stage was shown to be an independent prognostic factor for overall and disease-specific survival (89). In head and neck squamous cell carcinoma, the rationale for elective neck dissection in clinically node-negative patients is justified in case of a > 15% risk of occult lymph node metastases (90,91).…”

Expressão imuno-histoquímica das proteínas Jab1, p27, c-jun e c-fos no adenoma pleomórfico, adenocarcinoma polimorfo de baixo grau e carcinoma adenoide cístico das glândulas salivares

“…Este resultado opõe-se ao mostrado na literatura, onde a superexpressão de Jab1 em câncer de mama, adenocarcinoma de pâncreas, fígado, entre outras (16,17,62,(65)(66)(67), tem sido relacionada a um prognóstico pobre, sendo o CAC, entre as lesões aqui estudadas, a de pior prognóstico (9,10,(33)(34)(35) O APBG mostrou expressão de Jab1 semelhante aos ductos ao considerar casos apenas os casos positivos e não a graduação por escores, sendo assim, seu resultado em comparação ao CAC foi estatisticamente maior, concordando com as considerações feitas em relação ao CAC e Jab1, pois o APBG, apesar de ser maligno como o CAC, seu grau da malignidade é baixo e consequentemente, seu prognóstico é menos sombrio. Esse resultado, assim como em relação ao CAC, de que provavelmente haja interferência de outros fatores, como a interação de outras proteínas e vias de sinalização com Jab1.…”