Department of ENT-Head and Neck Surgery, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, F-75010 Paris, France.
French Armed Forces Biomedical Research Institute, F-91220 Brétigny sur Orge, France; Head and Neck Oncology Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, F-94807 Villejuif, France.
Eur J Cancer. 2023 May;185:11-27. doi: 10.1016/j.ejca.2023.02.020. Epub 2023 Mar 2.
Acinic cell carcinomas (AciCCs) are malignant tumours of the salivary glands. The aim of this work was to analyse data from the national REFCOR multicenter cohort (i) to investigate the prognostic factors influencing survival outcomes in AciCC, (ii) to assess the impact on survival of postoperative radiotherapy (RT) in patients treated for AciCC without high-grade transformation and (iii) to explore the prognostic impact of prophylactic neck dissection (ND) in patients treated for AciCC of the major salivary glands.
Data from all the patients treated for salivary AciCC between 2009 and 2020 were extracted from the REFCOR database. Survival outcomes and prognostic factors influencing Disease-Free Survival (DFS) and Overall Survival (OS) were investigated using univariate and multivariate analyses. Propensity score matching was used to assess the impact of postoperative RT and prophylactic ND on DFS.
A total of 187 patients were included. After a median follow-up of 53 months, their 5-year OS and DFS rates were 92.8% and 76.2%, respectively. In multivariate analysis, male sex, older age, higher T and N status, and high grade were independently associated with a worse DFS. In the subpopulation analysed after propensity score matching, patients with cN0 AciCC without high-grade transformation who were treated by surgery and RT did not have an improved DFS compared to patients who were treated by surgery alone (hazard ratio (HR) = 0.87, p = 0.8). Factors associated with nodal invasion were T3-T4 status and intermediate/high histological grade. After propensity score matching, prophylactic ND was associated with a trend toward a better DFS (HR = 0.46, p = 0.16).
These results suggest that (i) long-term follow-up (>5 years) should be considered in patients with AciCC, (ii) treatment by surgery alone could be an option in selected cN0 patients with AciCC without high-grade transformation and (iii) prophylactic ND may be considered preferentially in patients with T3-T4 status and/or intermediate/high histological grade.
涎腺腺样囊性癌（AciCC）是一种恶性唾液腺肿瘤。本研究的目的是分析来自全国性 REFCOR 多中心队列的数据：（i）研究影响 AciCC 患者生存结局的预后因素；（ii）评估无高级别转化的 AciCC 患者术后放疗（RT）对生存的影响；（iii）探讨预防性颈清扫术（ND）在治疗大唾液腺 AciCC 患者中的预后影响。
从 REFCOR 数据库中提取 2009 年至 2020 年间所有接受涎腺 AciCC 治疗的患者数据。采用单因素和多因素分析方法研究无病生存率（DFS）和总生存率（OS）的生存结果和影响因素。采用倾向评分匹配法评估术后 RT 和预防性 ND 对 DFS 的影响。
共纳入 187 例患者。中位随访 53 个月后，其 5 年 OS 和 DFS 率分别为 92.8%和 76.2%。多因素分析显示，男性、年龄较大、T 和 N 分期较高以及高级别与较差的 DFS 相关。在倾向评分匹配后分析的亚组中，无高级别转化的 cN0 AciCC 患者接受手术和 RT 治疗与单独手术治疗相比，DFS 无改善（风险比（HR）=0.87，p=0.8）。与淋巴结侵犯相关的因素是 T3-T4 分期和中/高级别组织学分级。经倾向评分匹配后，预防性 ND 与 DFS 改善趋势相关（HR=0.46，p=0.16）。
这些结果表明：（i）AciCC 患者需要进行长期（>5 年）随访；（ii）对于无高级别转化的 cN0 AciCC 患者，单独手术治疗可能是一种选择；（iii）对于 T3-T4 分期和/或中/高级别组织学分级的患者，可优先考虑预防性 ND。
