Purpose: Adenoid cystic carcinoma (ACC) is a relatively uncommon salivary gland malignancy known for its protean phenotypic features and pernicious clinical behavior. Currently, no effective therapy is available for patients with advanced nonresectable, recurrent, and/or metastatic disease. The purpose of this study is to identify prognostic factors other than tumor stage that can be used to predict the outcome of the patients with ACC. Experimental Design: We used comparative genomic hybridization (CGH) to identify copy number aberrations in 53 primaryACCs. Array CGH and fluorescence in situ hybridization analysis was used to validate CGH results on selected cases.We correlated these copy number aberrations with clinicopathologic factors using Pearson's m 2 or by the two-tailed Fisher exact test. The disease-specific survival and disease-free intervals were generated by the Kaplan-Meier product limit method. Results: Chromosomal losses (n = 134) were more frequent than gains (n = 74). The most frequent genetic change was the loss of 1p32-p36 in 44% of the cases followed by 6q23-q27, and 12q12-q14. The most frequently gained chromosomal regions were 8 and 18. Of the chromosomal aberrations, loss of 1p32-p36 was the only abnormality significantly associated with patient's outcome. Conclusions: This study, for the first time, identifies loss of 1p32-p36 as a significant aberration in ACC. Molecular characterization of 1p32-36 region using the available genomic technologies may lead to the identification of new genes critical to the development of novel therapeutic targets for this disease copy number aberration.Adenoid cystic carcinoma (ACC) is an uncommon salivary gland malignancy characterized by heterogeneous phenotypic features and persistently progressive biological behavior (1 -6). Histopathologically, ACC manifests three histologic patterns, including the solid, cribriform, and tubular forms, in variable combination and dominance (7). The solid pattern is typically associated with aggressive clinical course. ACCs are known for their proclivity to perineural invasion, which significantly contribute to the intractable nature of this disease (1,8,9). Surgical resection with and without postoperative radiotherapy remains the primary treatment modality for the management of this disease. However, patients with advanced local presentation, recurrence, and/or distant metastasis have limited therapeutic options (8, 9). Therefore, elucidation of molecular events that predict the malignant risk is critical in understanding the biology, clinical behavior, and management of ACC.Previous conventional cytogenetic studies of ACC, although limited in numbers and scope, have revealed translocations involving chromosome 6q with multiple chromosomal partners (10, 11). Subsequent analysis, using comparative genomic hybridization (CGH) of these tumors have reported recurrent chromosomal gains of 16p, 17q, 19, and 22q13 and losses at 6q23-qter, 12q12-q13, 13q21-q22, and 19 (12, 13). Recently, an array CGH study of 18 p...