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

Daniel Monteiro, João Lino, Teresa Bernardo, João Fernandes, Eurico Monteiro

Department of Otorhinolaryngology and Head and Neck Surgery, Portuguese Institute of Oncology, Porto, Portugal.
Department of Otorhinolaryngology and Head and Neck Surgery, Saint Antonio Hospital, Porto, Portugal.

DOI: 10.4236/ijohns.2013.25036                

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.

Keywords

Adenoid Cystic Carcinoma; Head and Neck Cancer; Prognostic Factors

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. C. Perez, F. A. Alves, I. N. Nishimoto, O. P. Almeida, et al., “Prognostic Factors in Head and Neck Adenoid Cystic Carcinoma,” Oral Oncology, Vol. 42, No. 2, 2006, pp. 139-146.
[2]	L. Ciccolallo, L. Licitra, G. Cantú, G. Gatta, et al., “Survival from Salivary Glands Adenoid Cystic Carcinoma in European Population,” Oral Oncology, Vol. 45, No. 8, 2009, pp. 669-674. doi:10.1016/j.oraloncology.2008.10.010
[3]	S. Chummun, N. R. McLean, C. G. Kelly, P. J. Dawas, et al., “Adenoid Cystic Carcinoma of the Head and Neck,” British Journal of Plastic Surgery, Vol. 54, No. 6, 2001, pp. 476-480. doi:10.1054/bjps.2001.3636
[4]	N. M. Rodriguez, I. L. Berrocal, L. R. Alonso, O. A. Irimia, et al., “Epidemiology and Treatment of Adenoid Cystic Carcinoma of the Minor Salivary Glands: A MetaAnalytic Study,” Medicina Oral Patologia Oral y Cirugia Bucal, Vol. 16, No. 7, 2011, pp. 884-889. doi:10.4317/medoral.17200
[5]	A. J. Khan, M. P. DiGiovanna, D. A. Ross, C. T. Sasaki, et al., “Adenoid Cystic Carcinoma: A Retrospective Clinical Review,” Radiation Oncology Investigations, Vol. 96, No. 3, 2001, pp. 149-158.
[6]	H. Wang, L. Xu and F. Li, “Subglottic Adenoid Cystic Carcinoma Mistaken for Asthma,” Journal of Zhejiang University Science B, Vol. 10, No. 9, 2009, pp. 707-710. doi:10.1631/jzus.B0920071
[7]	A. M. Chen, M. K. Bucci, V. Weinberg, J. Garcia, et al., “Adenoid Cystic Carcinoma of the Head and Neck Treated by Surgery with or without Postoperative Radiotion Therapy: Prognostic Features of Recurrence,” International Journal of Radiation Oncology Biology Physics, Vol. 66, No. 1, 2006, pp. 152-159.
[8]	N. G. Iyer, L. Kim, I. J. Nixon, F. Palmer, et al., “Factores Predicting Outcome in Malignant Minor Salivary Gland Tumors of the Oropharynx,” Archives of Otolaryngology—Head and Neck Surgery, Vol. 136, No. 12, 2010, pp. 1240-1247.
[9]	C. L. Ellington, M. Goodman, S. A. Kono, W. Grist, et al., “Adenoid Cystic Carcinoma of the Head and Neck: Incidence and Survival Trends Based on 1973-2007 Surveillance, Epidemiologym and End Resuls Data,” Cancer, Vol. 118, 2012, pp. 4444-4451. doi:10.1002/cncr.27408
[10]	F. A. Oliveira, E. C. B. Duarte, C. T. Taveira, A. A. Máximo, et al., “Salivary Gland Tumor: A Review of 599 Cases in a Brazilian Population,” Head and Neck Pathology, Vol. 3, No. 4, 2009, pp. 271-275. doi:10.1007/s12105-009-0139-9
[11]	R. Srivastava and N. Bhatia, “Adenoid Cystic Carcinoma of Larynx,” IJO & HNS, Vol. 49, No. 3, 1997, pp. 280-281.
[12]	P. B. Zald, M. W. Weber and J. Schindler, “Adenoid Cystic Carcinoma of Subglotic Larynx: A Case Report and Review of the Literature,” Ear Nose Throat Journal, Vol. 89, No. 4, 2010, p. E27.
[13]	A. D. Negro, E. Ichihara, A. J. Tncani and A. Altemani, “Laryngeal Adenoid Cystic Carcinoma: Case Report,” Sao Paulo Medical Journal, Vol. 125, No. 5, 2007, pp. 295-296. doi:10.1590/S1516-31802007000500010
[14]	E. Zvrko and M. Golubovic, “Laryngeal Adenoid Cystic Carcinoma,” Acta Otorhinolaryngologica Italica, Vol. 29, No. 5, 2009, pp. 279-282.
[15]	D. A. Silverman, T. P. Carlson, D. Khuntia, et al., “Role for Postoperative Radiation Therapy in Adenoid Cystic Carcinoma of the Head and Neck,” Laryngoscope, Vol. 114, No. 7, 2004, pp. 1194-1199. doi:10.1097/00005537-200407000-00012
[16]	A. T. N. N. Alves, F. D. Soares, A. S. Junior, Medeiros, et al., “Carcinoma Adenóide Cístico: Revisao da Literatura e Relato de Caso Clínico,” Brasileiro de Patologia e Medicina Laboratorial, Vol. 40, 2004, pp. 421-424.
[17]	S. C. Lee and J. T. Johnson, “Salivary Glands Neoplasms,” eMedicine Specialties, 2009. http://emedicine.medscape.com/article/852373-overview
[18]	www.cancer.net. http://www.cancer.net/patient/Cancer+Types/Adenoid+Cystic+Carcinoma?sectionTitle=Overview