Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy.
Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy.
Oral Oncol. 2022 Mar;126:105764. doi: 10.1016/j.oraloncology.2022.105764. Epub 2022 Feb 11.
Adenoid cystic carcinoma (AdCC) is a rare disease, with indolent behavior and poor long-term survival. Many studies have evaluated the role of clinical and pathological factors at presentation on the risk of recurrence. In this study we investigated whether baseline demographic, clinical, and pathological characteristics at the time of primary curative treatment could influence the prognosis of patients once local and/or distant recurrence occurred.
All patients affected by primary salivary gland AdCC and treated with curative surgery from January 1997 to June 2016 were reviewed, evaluating those who later developed loco-regional recurrence and/or distant metastasis. Time from the first relapse to death (recurrent/metastatic overall survival, RMOS) was considered the outcome of interest.
Out of 87 surgically treated AdCC patients, 36 relapsing lesions were included. Median ages at first presentation and recurrence were 55 and 60-year-old, respectively; 58% were females. Median disease-free-interval (DFI) was 22.0 months. Five-year RMOS was 47%. At univariate analysis, age ≥ 60-year-old (HR:2.67, p = 0.030), primary tumor lympho-vascular invasion (LVI) (HR:5.38, p = 0.003), adjuvant radiotherapy (RT) in the primary setting (HR:0.37, p = 0.043), and DFI < 30 months (HR:3.94, p = 0.008) significantly affected RMOS. Multivariable analysis confirmed the presence of LVI and shorter DFI as independent risk factors.
Knowledge of baseline clinicopathological features is helpful in the prognostic stratification of patients with recurrent AdCC, with LVI as the most relevant baseline factor. Adjuvant RT demonstrated its protective role on survival even once recurrence occurred, further supporting its adoption in the primary setting.
腺样囊性癌（AdCC）是一种罕见的疾病，其具有惰性的行为和较差的长期生存。许多研究已经评估了初诊时临床和病理因素与复发风险的关系。在本研究中，我们调查了原发性根治性治疗时的基线人口统计学、临床和病理特征是否会影响局部和/或远处复发后患者的预后。
回顾性分析了 1997 年 1 月至 2016 年 6 月期间接受根治性手术治疗的原发性涎腺腺样囊性癌患者，评估了后来发生局部复发和/或远处转移的患者。将首次复发至死亡的时间（复发/转移总生存期，RMOS）作为观察终点。
在 87 例接受手术治疗的 AdCC 患者中，有 36 例出现复发病灶。首次就诊和复发时的中位年龄分别为 55 岁和 60 岁；58%为女性。中位无疾病间期（DFI）为 22.0 个月。5 年 RMOS 为 47%。单因素分析显示，年龄≥60 岁（HR：2.67，p=0.030）、原发性肿瘤淋巴管血管侵犯（LVI）（HR：5.38，p=0.003）、原发性根治性放疗（RT）（HR：0.37，p=0.043）和 DFI＜30 个月（HR：3.94，p=0.008）显著影响 RMOS。多因素分析证实 LVI 和较短的 DFI 是独立的危险因素。
了解基线临床病理特征有助于对复发性 AdCC 患者进行预后分层，其中 LVI 是最重要的基线因素。即使发生复发，辅助 RT 也显示出对生存的保护作用，进一步支持其在原发性疾病中的应用。
