Survival In Adenoid Cystic Carcinoma Research Articles

Prognostic factors and survival in adenoid cystic carcinoma of the head and neck: A retrospective study

Prognostic factors and survival in adenoid cystic carcinoma of the head and neck: A retrospective study

997: Impact of Treatment Package Time on Survival in Adenoid Cystic Carcinoma of the Head and Neck

997: Impact of Treatment Package Time on Survival in Adenoid Cystic Carcinoma of the Head and Neck

A Low Systemic Inflammatory Response Index Is Associated With Improved Survival in Adenoid Cystic Carcinoma Patients

BackgroundPredicting the long-term survival in adenoid cystic carcinoma(ACC) patients remains is challenging. Inflammatory cell-based indices are emerging as prognostic indicators of oncology. PurposeThis study aimed to determine the associations between the preoperative systemic inflammatory response index (SIRI) and, systemic immunoinflammatory index (SII), and the 10-year survival rates in patients with ACC of the head and neck (ACCHN). Study Design, Setting, SampleThis retrospective cohort study comprised ACCHNN patients treated at the Chinese People's Liberation Army General Hospital between November 2003 and December 2020. Predictor VariableThe inflammatory response, assessed using the SIRI and SII, was the predictor variable, The optimal cut-off values were based on the maximum Youden index values (sensitivity ＋ specificity－1), The patients were divided into two-group each, based on the SIRI (low, ≤ 0.15) and (high, > 0.15), and SII (low, ≤ 562.8 and high, > 562.8) values. Outcome VariableOverall survival (OS), or the number of days, weeks, or months between treatment initiation and death (or last follow-up date), was the primary outcome variable. CovariatesThe covariates were classified as demographic (age, gender, body mass index), medical (hypertension, diabetes), inflammatory (neutrophils, lymphocytes, monocytes, platelets, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, neutrophil-lymphocyte ratio), and perioperative (tumor stage, lymph node metastasis, tumor size, treatment type). AnalysesDescriptive, univariate, and multivariate Cox proportional risk regression analyses were performed to determine whether the SIRI and SII were independent prognostic factors for OS. Kaplan–Meier survival curves and log-rank tests were used to determine their associations with the OS. ResultsThe study sample comprised 162 patients (mean age, 52 ± 14; males, 39.5%). The median follow-up time was 6.81 ± 0.23, and the 10-year OS rate was 7.68 ± 0.25. The low and high SIRI groups comprised 109 and 53 patients, while the low and high SII groups comprised 116 and 46 patients, respectively. SIRI was identified as a prognostic factor (P < 0.01; hazard ratio, 2.45; 95% confidence interval, 1.35–4.45). Conclusion and RelevanceThe SIRI has the advantages of reproducibility, convenience, non-invasiveness, and affordability, making it a promising prognostic inflammatory index for patients with ACCHN.

Rearrangements, Expression, and Clinical Significance of MYB and MYBL1 in Adenoid Cystic Carcinoma: A Multi-Institutional Study.

Simple SummaryAdenoid cystic carcinoma (ACC) is an aggressive glandular cancer with poor prognosis that preferentially occurs in the head and neck. The MYB and MYBL1 oncogenes are main oncogenic drivers, but the true frequency and clinical significance of these alterations are unclear. Here, we have used tissue microarrays to study these genes in a multi-institutional study of close to 400 ACCs, the largest study to date. We found alterations of MYB/MYBL1 in 78% of the cases and overexpression of the MYB/MYBL1 proteins in 93% of the cases. Importantly, we show that patients with loss of one part of the MYB gene and its neighboring sequences on chromosome 6 have a significantly shorter overall survival compared to those without loss. Our study provides new knowledge about the frequency and clinical significance of MYB/MYBL1 alterations and identifies genes with tumor suppressive functions on chromosome 6 that contribute to poor prognosis in ACC.Adenoid cystic carcinoma (ACC) is an aggressive head and neck malignancy characterized by a t (6;9) translocation resulting in an MYB–NFIB gene fusion or, more rarely, an MYBL1 fusion. The true frequency and clinical significance of these alterations are still unclear. Here, we have used tissue microarrays and analyzed 391 ACCs and 647 non-ACC salivary neoplasms to study the prevalence, expression, and clinical significance of MYB/MYBL1 alterations by FISH and immunohistochemistry. Alterations of MYB or MYBL1 were found in 78% of the cases, of which 62% had MYB alterations and 16% had MYBL1 rearrangements. Overexpression of MYB/MYBL1 oncoproteins was detected in 93% of the cases. MYB split signal, seen in 39% of the cases, was specific for ACC and not encountered in non-ACC salivary tumors. Loss of the 3′-part of MYB was enriched in grade 3 tumors and was a significant independent prognostic biomarker for overall survival in multivariate analyses. We hypothesize that loss of the 3′-part of MYB results from an unbalanced t(6;9) leading to an MYB–NFIB fusion with concomitant loss of the segment distal to the MYB breakpoint in 6q23.3. Our study provides new knowledge about the prevalence and clinical significance of MYB/MYBL1 alterations and indicates the presence of genes with tumor suppressive functions in 6q23.3-qter that contribute to poor prognosis and short overall survival in ACC.

Prognostic Factors and Survival in Adenoid Cystic Carcinoma of the Head and Neck: A Retrospective Clinical and Histopathological Analysis of Patients Seen at a Cancer Center.

Adenoid cystic carcinoma (AdCC) is a rare malignancy that accounts for approximately 1% of all head and neck cancers. This neoplasm is characterized by slow but often relentless growth and dissemination. Our aim was to retrospectively evaluate the clinical-pathological features of patients diagnosed with head and neck AdCC and to identify possible prognostic factors. This retrospective observational study analyzed 87 cases of AdCC of the head and neck. Clinical parameters (tumor size, lymph node and distant metastasis, clinical stage, and survival) were obtained from the records. Survival curves were constructed using the Kaplan-Meier method. A p value ≤ 0.05 was considered significant. There was a slight predominance of cases diagnosed in female patients (54%). The mean age at diagnosis was 51.5years. Analysis using Cox's proportional hazards model considering 10-year disease-specific survival identified histologic pattern and presence of perineural invasion as independent prognostic variables. Primary tumor size and distant metastasis were prognostic predictors of 5- and 10-year disease-free survival. Detailed analysis of the association between clinical-pathological parameters and prognosis can assist professionals with cancer treatment planning and adequate patient management. Considering the long-term aggressive behavior of AdCC, rigorous patient follow-up is important to identify possible locoregional or distant recurrences.

Predictors of Distant Metastasis and Survival in Adenoid Cystic Carcinoma of the External Auditory Canal.

To analyze the predictors of both distant metastasis and survival in patients with adenoid cystic carcinoma of the external auditory canal. Retrospective patient review. A single university hospital. Eighty-two cases with adenoid cystic carcinoma of the external auditory canal were referred to our institution between 2004 and 2016. Distant metastasis was detected by lung computed tomography, proton emission tomography computed tomography, or histopathologic examination of tissue samples. Distant metastasis predictors were analyzed using Student's t tests and χ tests. The log-rank tests of Kaplan-Meier survival curves were used to evaluate survival differences. During a median follow-up of 36 months (range, 6-162 mo), distant metastasis developed in 25 patients. The occurrence of distant metastasis was significantly associated with histopathologic subtype, T classification, and local recurrence (p < 0.05). The 1-, 10-, 20-, and 25-year cumulative survival rates in the patents with DM were 95.7, 95.7, 71.7, and 0%, respectively, and all survival rates were 100% for the 57 patients without distant metastasis (p = 0.115). Median survival time after occurrence of distant metastasis was 13 months (range, 1-120 mo). Prognosis was better with solely lung metastasis than with metastases to other visceral organs or bone (p < 0.05). Distant metastasis appeared to result in a poorer prognosis, occurrence of distant metastasis was significantly associated with local recurrence, extensive surgery is recommended to achieve local control and reduce distant metastasis risk. Routine follow-up investigations for detecting distant metastasis are warranted for patients with an increased risk for distant metastasis.

1146P - Impact of tumour site and adjuvant radiotherapy on survival in adenoid cystic carcinoma: A SEER database analysis

BackgroundAdenoid cystic carcinoma (ACC) is a rare salivary gland tumor, comprising less than 1% of head and neck neoplasms. Adjuvant radiotherapy (aRT) is suggested for late-stage disease (stage III or IV); however, recent evidence suggests that it may be associated with improved survival even for early-stage disease. Moreover, the prognostic significance of tumor location on overall (OS) and ACC-specific (ACC-S) survival is unclear. We sought to address these knowledge gaps via analyses of the Surveillance, Epidemiology and End Results (SEER) database. MethodsIntraoral minor (m) and major (M) ACCs from the SEER database (1973-2015) were selected for analysis. Information on age, sex, race, site, stage, treatment and survival was retrieved. The associations of tumor site and aRT with OS and ACC-S were estimated using hazard ratios (HR) and corresponding 95% confidence intervals (CI) obtained via Cox regression models adjusted for covariates as appropriate. Analyses were done using Stata 15.1 (StataCorp LP, College Station, TX). ResultsThere were 635 minor and 1,064 major (parotid: n=547, submandibular: n=470, sublingual: n=47) ACC cases included in the analyses. Late-stage patients (49% of total) were significantly more likely to have received aRT (76% vs. 66%; P<0.01) compared to those with early-stage disease. Submandibular was the only tumour site that demonstrated statistically significant survival differences compared to the other sites; i.e., worse OS (HR=1.4; 95% CI=1.1-1.8) and ACC-S (HR=1.7; 95% CI=1.2-2.3) compared to minor ACCs. This difference was only evident for late-stage tumours: stage IV submandibular cases had worse OS (HR=2.1; 95% CI=1.5-2.8) and ACC-S (HR=2.4; 95% CI=1.7-3.4) compared to stage IV minor ACCs. Overall, aRT was associated with better OS (HR=0.7; 95% CI=0.6-0.9) and ACC-S (HR=0.8; 95% CI=0.6-1.1). This beneficial effect was more pronounced and statistically confirmed only in stage IV disease. ConclusionsThese results, based on SEER data, suggest that aRT is associated with favorable survival only in late-stage ACC and that, among these late-stage tumors, submandibular gland ACCs have substantially worse prognosis than other sites, irrespective of aRT. Legal entity responsible for the studyThe authors. FundingAcademy of Athens PhD Scholarship to Jason Tasoulas; UNC Lineberger Tier 3 Developmental Award funds and the University Cancer Research Fund to A.L. Amelio. DisclosureAll authors have declared no conflicts of interest.

AF1q Expression Associates with CD44 and STAT3 and Impairs Overall Survival in Adenoid Cystic Carcinoma of the Head and Neck

Salivary gland malignancies of the head and neck form a heterogeneous group. Adenoid cystic carcinomas are an aggressive entity of salivary gland malignancies characterized by frequent distant metastases and poor response to radio- and chemotherapy. AF1Q is a MLL fusion partner, which can activate Wnt and STAT3 signaling. Recently, overexpression of AF1q has been identified as a poor prognosticator in patients of different malignancies. A total of 46 patients with adenoid cystic carcinoma were immunohistochemically evaluated for expression of AF1q and clinical outcome was analyzed in this context. Additionally, STAT3 and the Wnt downstream target CD44 were investigated and correlated with AF1q. AF1q was overexpressed in 52.2%. Overexpression of AF1q was associated with poorer overall survival (p = 0.03). Additionally, lymph node metastases and solid tumor parts were more frequently observed in AF1qhigh patients (p = 0.07 and 0.05, respectively). AF1q did not influence the occurrence of distant metastases. Expression of AF1q was associated with higher levels of STAT3 and CD44 (p = 0.003 and 0.006, respectively). AF1q is a novel prognostic marker for poor overall survival in adenoid cystic carcinoma patients. The deleterious effects on survival may be a result of promotion of the STAT3 and Wnt pathway.

ATAXIA-TELANGIECTASIA-MUTATED PROTEIN EXPRESSION AS A PROGNOSTIC MARKER IN ADENOID CYSTIC CARCINOMA OF SALIVARY GLANDS

Adenoid cystic carcinoma (ACC) is one of the high grade malignant tumors in salivary glands, prognosticallycharacterized by multiple recurrences and late distant metastasis. Recently, Myb-NFIB fusion or rearrangements of Myb have been detected as a hallmark of ACC. However, no biological marker estimating the outcome of ACC has been proven yet. Purpose of this study was to investigate whether the protein expression of ATM gene is related to patients’ survival in ACC. Experimental Design This study consists of 48 surgical samples for detecting expression of ATM and its downstream p53. Kaplan-Meier plots were used to evaluate the relationship between the protein expression ratios of ATM, p53 and its ATM-mediated phosphorylation and the overall survival rate of patients with ACC. Results low expression of ATM in cancer cells correlated with poor survival rate (p = 0.037). However, low expression of ATM in stromal fibroblasts was not significantly associated with patient outcome. Moreover, this study evaluated ATM expression stratified by p53 and its ATM-mediated phosphorylation status. ATM loss was associated with a significantly decreased overall survival in patients simultaneously showing overexprssion of p53 (p = 0.01) and low expression of p53 phospho S15 (p = 0.05). These data supported that loss of ATM and its functional status in p53 pathway is an important factor associated with poor outcome of patients in ACC of salivary glands.

Prognostic factors and survival in adenoid cystic carcinoma of the sinonasal cavity.

Optimal treatment and prognostic factors affecting long-term survival in patients with sinonasal adenoid cystic carcinoma (ACC) have yet to be clearly defined. We conducted a retrospective review of patients treated with curative intent from 1980-2015 at MD Anderson Cancer Center. One hundred sixty patients met inclusion criteria, including 8 who were treated with radiotherapy alone. Median follow-up time was 55 months. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 67.0% and 49.0%, respectively. The 10-year OS and DFS rates were 44.8% and 25.4%, respectively. Factors that portended for poor survival on multivariate analysis were recurrent disease, any solid type histology, epicenter in the sinus cavity, the presence of facial symptoms, or the original disease not treated with surgery. There was no association between surgical margin status or nodal status and survival. In this large cohort of patients with sinonasal ACC with extended follow-up, long-term survival is better than reported in prior literature. Future research should target patients with adverse risk factors.

Abnormal activation of the Akt signaling pathway in adenoid cystic carcinoma.

Adenoid cystic carcinoma (ACC) is an intriguing lesion because it shows a slow growth in the beginning, but a late poor prognosis due to perineural invasion, metastasis and recurrence. This study aimed to investigate whether Akt signaling would be deregulated in adenoid cystic carcinoma and its consequence in the expression of associated proteins. The expression of the Akt, p-Akt, NFκB, β-catenin, cyclin D1 and COX-2 was assessed by immunohistochemistry in 10 cases of ACC, 17 cases of pleomorphic adenoma (PA), and 7 cases of normal salivary gland (NSG). p-Akt was overexpressed in ACC when compared to NSG. NFκB, β-catenin, and COX-2 were overexpressed in ACC and PA when compared to NSG. Most proteins were slightly higher expressed in ACC than in PA, but they never reached significance. p-Akt expression positively correlated with NFκB, β-catenin, cyclin D1 and COX-2 in ACC and PA, while this correlation trended to be negative in for these proteins (except for NFκB) in NSG using Person's correlation analysis, but without reaching significance. Our results indicate an abnormal activation of Akt signaling pathway, which can be an important regulator of tumor biology in ACC. Activated Akt correlated with the expression of NFκB, β-catenin and COX-2, which can potentially influence cell survival in ACC.

Pretreatment quantitative 18F-FDG PET/CT parameters as a predictor of survival in adenoid cystic carcinoma of the salivary glands

PurposeThe aim of this study was to determine the unique prognostic value of quantitative 18F-FDG PET/CT parameters to assess progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS) in patients with salivary gland adenoid cystic carcinoma (ACC). MethodsWe performed a retrospective study including 23 patients (15 men, 8 women; median age, 58 years; range, 21–91 years) with salivary gland ACC between January 2009 and October 2017 who underwent 18F-FDG PET/CT scan prior to treatment. Maximum, mean, peak, tumor-to-mediastinal blood pool and tumor-to-liver standardized uptake values (SUVmax, SUVmean, SUVpeak, SUVratio[med] and SUVratio[liver]), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained from 18F-FDG PET/CT. The prognostic value of quantitative 18F-FDG PET/CT parameters and other clinicopathological variables were evaluated utilizing the Cox proportional regression analysis. ResultsThe 3-year and 5-year OS for all the patients were 90.9%, and 62.3%, respectively. Log rank test determined that the SUVratio[med], SUVratio[liver], MTV and TLG were predictive factors of DMFS, PFS, and OS (p < 0.05), furthermore, SUVmax, minor salivary gland tumors and DM at initial diagnosis (M1 stage) were predictor for PFS; M1 stage and overall stage 3–4 predicted DMFS (all p < 0.05). Cox regression analyses confirmed that the higher SUVratio[med], SUVratio[liver], MTV, and TLG values predicted DMFS, PFS and OS independently, whereas SUVmax was an independent predictor of only PFS (p < 0.05). ConclusionsThe pretreatment metabolic 18F-FDG PET/CT parameters may reflect tumor aggressiveness in patients with salivary gland ACC and may potentially be utilized as a prognostic biomarker.

Overview of benign and malignant lacrimal gland tumors.

The goal of this article is to review the key clinical and radiological features, treatment strategies, and prognosis of lacrimal gland tumors. Debulking of the orbital lobe of the lacrimal gland may offer improved control rates in dacryoadenitis without compromise of tear film function. Contrary to previous belief, careful biopsy of the lacrimal gland prior to excision does not appear to increase the risk of recurrence in cases with suspected pleomorphic adenoma. Low-dose radiation (4 Gy) in two 2-Gy fractions appears to be effective and well tolerated in indolent non-Hodgkin lymphoma of the ocular adnexa with high local control rate. Eye-sparing surgery for adenoid cystic carcinoma (ACC) leaving minimal or no tumor residual in the orbit followed by adjuvant radiation therapy or chemoradiotherapy may provide good local control and long-term survival outcomes. Intra-arterial chemotherapy has been found to decrease recurrence and improve survival in ACC and can also be used as part of an eye-sparing treatment strategy. The development of targeted drugs may offer palliation for patients with unresectable or metastatic disease in lacrimal gland carcinoma. This article offers an update on diagnosis, management, and prognosis of the major lacrimal gland lesions.

Ataxia-Telangiectasia-Mutated Protein Expression as a Prognostic Marker in Adenoid Cystic Carcinoma of the Salivary Glands.

PurposeAdenoid cystic carcinoma (ACC) is a high-grade malignant tumor of the salivary glands, clinically characterized by multiple recurrences and late distant metastasis. Biological markers for assessing the prognosis of ACC have remained elusive. The purpose of this study was to investigate whether the protein expressions of ataxia telangiectasia mutated (ATM), p53, and ATM-mediated phosphorylated p53 are related to patient survival in ACC.Materials and MethodsIn this study, 48 surgical samples were used to assess the expressions of ATM and its downstream target p53. Fisher's exact test and Kaplan-Meier analysis were conducted to evaluate the role of ATM, p53, and phospho-p53 (S15) protein expressions in predicting patient survival and distant metastasis.ResultsMyb expression was positive in 85.4% of ACCs, but did not reflect patient survival rate. In contrast, low expression of ATM in cancer cells was significantly correlated with poor survival rate (p=0.037). Moreover, under positive p53 expression, low expression of ATM was highly predictive of poor survival in ACC (p=0.017).ConclusionThese data indicate that combined assessment of ATM and p53 expression can serve as a useful prognostic marker for assessing survival rate in patients with ACC of the salivary glands.

Prediction of distant metastasis and survival in adenoid cystic carcinoma using quantitative 18F-FDG PET/CT measurements

ObjectivesAdenoid cystic carcinoma (AdCC) in the salivary gland shows a high rate of distant metastasis, which is related to the resulting poor prognosis. We therefore examined the role of pretreatment 18F-FDG PET/CT for prediction of distant metastasis, recurrence/progression, and survival in AdCC. MethodsThis study included 52 patients who underwent pretreatment 18F-FDG PET/CT scanning and subsequent treatments for AdCC. Maximum, mean, and peak standardized uptake value (SUVmax, SUVmean, and SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured on 18F-FDG PET/CT. Univariate and multivariate Cox proportional hazards regression analyses were used to identify associations between the quantitative measurements of 18F-FDG PET, and progression-free survival (PFS), distant metastasis-free survival (DMFS), and disease-specific survival (DSS). ResultsDistant metastases were found in 20 (39%) patients: 6 (12%) at initial diagnosis and 14 (27%) during the median follow-up of 72 months after treatment. Univariate analyses showed that all the 18F-FDG PET parameters of SUVmax, SUVmean, SUVpeak, MTV, and TLG were significantly associated with overall PFS, DMFS, and OS (all P < .05). After controlling for clinicopathological variables, SUVmax remained an independent factor predictive of PFS (P = .001), while MTV and TLG were independent predictors of DMFS (P = .009) and DSS (P = .017). Patients with MTV > 14.8 mL showed a 5.9-fold higher risk of distant metastasis and a 4.2-fold higher risk of disease-specific death than those with a lower MTV. ConclusionsQuantitative measurements using 18F-FDG PET/CT are useful for predicting tumor progression, distant metastasis, and survival in patients with AdCC.

MYB, MYBL1, MYBL2 and NFIB gene alterations and MYC overexpression in salivary gland adenoid cystic carcinoma.

Adenoid cystic carcinoma (AdCC) is one of the most common salivary gland malignancies and the long-term prognosis is poor. In this study, we examined alterations of AdCC-associated genes, MYB, MYBL1, MYBL2 and NFIB, and their target molecules, including MYC. The results were correlated to clinicopathological profile of the patients. Using paraffin tumour sections from 33 cases of salivary gland AdCC, we performed a detailed fluorescence in-situ hybridization (FISH) analysis for gene splits and fusions of MYB, MYBL1, MYBL2 and NFIB. We found that 29 of 33 (88%) AdCC cases showed gene splits in either MYB, MYBL1 or NFIB. None of the cases showed an MYBL2 gene alteration. AdCCs were divided genetically into six gene groups, MYB-NFIB (n=16), MYB-X (n=4), MYBL1-NFIB (n=2), MYBL1-X (n=1), NFIB-X (n=6) and gene-split-negative (n=4). AdCC patients showing the MYB or MYBL1 gene splits were associated with microscopically positive surgical margins (P=0.0148) and overexpression of MYC (P=0.0164). MYC expression was detected in both ductal and myoepithelial tumour cells, and MYC overexpression was associated with shorter disease-free survival of the patients (P=0.0268). The present study suggests that (1) nearly 90% of AdCCs may have gene alterations of either MYB, MYBL1 or NFIB, suggesting the diagnostic utility of the FISH assay, (2) MYB or MYBL1 gene splits may be associated with local aggressiveness of the tumours and overexpression of MYC, which is one of the oncogenic MYB/MYBL1 targets and (3) MYC overexpression may be a risk factor for disease-free survival in AdCC.

Prognostic significance of p53 immunohistochemical expression in adenoid cystic carcinoma of the salivary glands: a meta-analysis.

Adenoid cystic carcinoma of salivary glands is a rare adenocarcinoma and has been placed in “high-risk” category as poor long-term prognosis. The purpose of this study was to investigate p53 protein expression in adenoid cystic carcinoma of salivary glands and its correlation with clinicopathological parameters and prognosis. Literatures were searched from PubMed, Embase, Cochrane Library and Web of Science, which investigated the relationships between p53 expression and pathological type, clinical stage, local recurrence, metastasis, nerve infiltration and overall survival. A total of 1,608 patients from 36 studies were included in the analysis. The results showed that p53-postive expression rate was 49% in adenoid cystic carcinoma of salivary glands (OR=10.34, 95%CI: 4.93-21.71, P < 0.0001). The p53-postive expression was closely related to tumor types (OR=0.30, 95%CI: 0.14-0.65, P < 0.0001). The tumor with solid histological subtype had a strong positive correlation with p53 expression. The combined analysis revealed that the p53-positive expression rate among patients in T1and T2 stage was 41.4%, compared to 53.2% among those in T3 and T4 stage. However, there was no significant correlation between tumor stage and p53 expression (OR=0.47, 95% CI: 0.17-1.29, P = 0.14). Besides, compared to patients with p53-negative expression, those with p53-positive expression had a greater chance of developing metastasis, local recurrence and nerve infiltration as well as poorer 5-year overall survival (P < 0.01). In conclusion, the p53 expression is related to the survival of adenoid cystic carcinoma of salivary glands. It can be considered as the auxiliary detection index in treatment and prognosis of adenoid cystic carcinoma of salivary glands.

VEGF and Ki-67 Overexpression in Predicting Poor Overall Survival in Adenoid Cystic Carcinoma.

PurposeThe purpose of this study was to evaluate potential prognostic factors in patients with adenoid cystic carcinoma (ACC).Materials and MethodsA total of 68 patients who underwent curative surgery and had available tissue were enrolled in this study. Their medical records and pathologic slides were reviewed and immunohistochemistry for basic fibroblast growth factor, fibroblast growth factor receptor (FGFR) 2, FGFR3, c-kit, Myb proto-oncogene protein, platelet-derived growth factor receptor beta, vascular endothelial growth factor (VEGF), and Ki-67 was performed. Univariate and multivariate analysis was performed for determination of disease-free survival (DFS) and overall survival (OS).ResultsIn univariate analyses, primary site of nasal cavity and paranasal sinus (p=0.022) and Ki-67 expression of more than 7% (p=0.001) were statistically significant factors for poor DFS. Regarding OS, perineural invasion (p=0.032), high expression of VEGF (p=0.033), and high expression of Ki-67 (p=0.007) were poor prognostic factors. In multivariate analyses, primary site of nasal cavity and paranasal sinus (p=0.028) and high expression of Ki-67 (p=0.004) were independent risk factors for poor DFS, and high expression of VEGF (p=0.011) and Ki-67 (p=0.011) showed independent association with poor OS.ConclusionHigh expression of VEGF and Ki-67 were independent poor prognostic factors for OS in ACC.

Clinicopathologic predictors of recurrence and overall survival in adenoid cystic carcinoma of the head and neck: A single institutional experience at a tertiary care center

The purpose of this study was to determine factors that impact recurrence and long-term survival of head and neck adenoid cystic carcinoma (ACC). We conducted a retrospective review of 87 patients with head and neck ACC who were evaluated between 1992 and 2009. Staining for Ki-67, p53, α-estrogen receptor (αER), and progesterone receptor (PR) was performed. Forty men (46%) and 47 women (54%) were included in this study. Median follow-up for patients was 98 months. Five-year recurrence-free and overall survival (OS) rates were 56% and 81%, respectively. Ki-67 and p53 expression was observed in 5 (6%) and 2 (2%) patients, respectively. αER and PR were all negative. The most important determinants of disease-free survival (DFS) were perineural invasion (PNI; p = .001) and female sex (p = .027). Disease site (major vs minor salivary gland) was the only predictor of worse OS on multivariate analysis. Perineural invasion, female sex, and disease site were the most consistent predictors of poor outcome in head and neck ACC.

Distant metastasis and survival of adenoid cystic carcinoma after definitive treatment

ObjectiveAdenoid cystic carcinoma (ACC) is an aggressive tumor and characterized by late development of distant metastases (DM). The aim of study was to analyze the clinicopathological predictors of DM in ACC and to determine survival after the development of DM. MethodsThirty patients with ACC treated by surgery and/or radiotherapy were included. The impact of clinicopathological factors on DM was assessed. Factors included primary site, T stage, histological growth pattern, surgical margin, perineural invasion (PNI), postoperative radiotherapy (PORT) and local recurrence. The median follow-up was 62 months (range, 3–267 months). ResultsTwenty-four patients have relapsed local and/or distant metastases. The most common pattern of tumor relapse was DM, which developed in 17 patients. The 5-year, 10-year, and 15-year disease-free survival rate was 46%, 19%, and 15%, respectively. The positive surgical margin was significantly associated with DM rate. Neither primary site, T stage, histologic growth pattern, PNI, PORT nor local recurrence influenced on DM rates. The median survival period after the detection of DM for lung metastasis alone or bone and others were 47 months and 19 months, respectively (P=0.03). ConclusionsACC develops DM frequently even without locoregional recurrences. Only the status of surgical margins showed an association with the occurrence of DM. The survival of patients developing DM is significantly associated with the site of metastases and better in patients with lung compared to bone and other organs. A multimodality treatment approach including chemotherapy and molecular targets therapy is warranted to treat distant metastatic disease.