Li Han, Zhao Li, Song Yixuan, Liu Yang, Ni Song, Liu Shaoyan
Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ear Nose Throat J. 2023 Oct 20:1455613231207262. doi: 10.1177/01455613231207262.
Adenoid cystic carcinoma (ACC) is an aggressive cancer that often leads to poor prognosis, especially when it has metastasized. The prognostic significance of primary tumor surgery (PTS) for ACC with distant metastasis (DM) at the time of diagnosis has not been extensively studied. Using data from the surveillance, epidemiology, and end results (SEER) database from 2010 to 2019, we identified patients with ACC in head and neck region and synchronous DM. We evaluated the effect of PTS on different patterns of metastasis using Kaplan-Meier analysis, log-rank tests, and multivariate Cox regression analysis to assess the therapeutic benefit of PTS in the overall cohort and various subgroups. Of the 192 identified patients with synchronous metastatic ACC of head and neck, 91 (47.4%) underwent PTS. Patients who received PTS had significantly better survival than nonsurgical patients (median overall survival: 19 vs 43 months, = .006). Cox regression analysis also showed that PTS was associated with improved survival (HR = .46, 95% CI: 0.42-0.88; = .028). In sub-analyses, except for patients with liver metastases [overall survival (OS), = .107, cancer-specific survival (CSS), = .153], PTS consistently conferred significant survival benefits in patients with bone metastases (OS, = .041, CSS, = .065) and lung metastases (OS, = .016, CSS, = .027). PTS also led to better survival in patients who did not receive radiotherapy (median OS: 13 vs 52 months, = .007). Our study suggests that PTS in metastatic ACC patients of head and neck improved overall and CSS, particularly in those with bone or lung metastases and those who did not receive radiotherapy. However, further prospective studies are needed to confirm these findings, and the indications for PTS in metastatic ACC should be carefully evaluated by a multidisciplinary board.
腺样囊性癌（ACC）是一种侵袭性癌症，往往导致预后不良，尤其是发生转移时。对于诊断时伴有远处转移（DM）的ACC患者，原发肿瘤手术（PTS）的预后意义尚未得到广泛研究。利用2010年至2019年监测、流行病学和最终结果（SEER）数据库的数据，我们确定了头颈部ACC且伴有同步DM的患者。我们使用Kaplan-Meier分析、对数秩检验和多变量Cox回归分析评估PTS对不同转移模式的影响，以评估PTS在整个队列和各个亚组中的治疗益处。在192例确诊的头颈部同步转移性ACC患者中，91例（47.4%）接受了PTS。接受PTS的患者生存率明显高于未接受手术的患者（中位总生存期：19个月对43个月，P = 0.006）。Cox回归分析还表明，PTS与生存率提高相关（风险比=0.46，95%置信区间：0.42 - 0.88；P = 0.028）。在亚分析中，除肝转移患者外[总生存期（OS），P = 0.107，癌症特异性生存期（CSS），P = 0.153]，PTS在骨转移患者（OS，P = 0.041，CSS，P = 0.065）和肺转移患者（OS，P = 0.016，CSS，P = 0.027）中始终具有显著的生存益处。PTS在未接受放疗的患者中也带来了更好的生存率（中位OS：13个月对52个月，P = 0.007）。我们的研究表明，头颈部转移性ACC患者接受PTS可改善总生存期和癌症特异性生存期，特别是在骨或肺转移患者以及未接受放疗的患者中。然而，需要进一步的前瞻性研究来证实这些发现，并且转移性ACC患者PTS的适应证应由多学科团队仔细评估。
