Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma
Abstract Background Management of locoregional recurrence (LRR) and distant metastasis (DM) in adenoid cystic carcinoma (ACC) is guided by limited data. We investigated mortality risks in patients diagnosed and treated for recurrent ACC. Methods A retrospective review of ACC patients treated from 19...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40463-018-0273-z |
| _version_ | 1797971489568325632 |
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| author | Melody J. Xu Tara J. Wu Annemieke van Zante Ivan H. El-Sayed Alain P. Algazi William R. Ryan Patrick K. Ha Sue S. Yom |
| author_facet | Melody J. Xu Tara J. Wu Annemieke van Zante Ivan H. El-Sayed Alain P. Algazi William R. Ryan Patrick K. Ha Sue S. Yom |
| author_sort | Melody J. Xu |
| collection | DOAJ |
| description | Abstract Background Management of locoregional recurrence (LRR) and distant metastasis (DM) in adenoid cystic carcinoma (ACC) is guided by limited data. We investigated mortality risks in patients diagnosed and treated for recurrent ACC. Methods A retrospective review of ACC patients treated from 1989 to 2016 identified 36 patients with LRR or DM. High-risk disease was defined as skull base involvement (for LRR) or International Registry of Lung Metastases Group III/IV or extrapulmonary site of metastasis (for DM). Kaplan-Meier method, log-rank tests, and Cox proportional hazards were used for time-to-event analysis. Results Among 20 LRR and 16 DM patients, the median times to recurrence were 51 and 50 months, respectively. The median follow-up post-recurrence was 37.5 months (interquartile range (IQR)16.5–56.5). Post-recurrence 3-year overall survival (OS) was 78.5%, 73.3% for LRR and 85.1% for DM (p = 0.62). High-risk recurrences were associated with worse 3-year OS (68.8% for high-risk and 92.3% for low-risk, χ2 = 10.4, p = 0.001). Among LRR patients, 90% had surgery as part of their treatment. Multimodality therapy, age, and histopathologic features (size, margins, solid histology, lymphovascular or perineural invasion) were not associated with PFS or OS. High-risk LRR was the only variable associated with OS (χ2 = 5.9, p = 0.01). Among DM patients, six were initially managed with observation and ten received surgery, RT, or systemic therapy. Upfront therapy was not associated with improved PFS or OS. High-risk DM was the only variable associated with OS (χ2 = 4.7, p = 0.03). Conclusions High-risk LRR and DM were associated with decreased 3-year OS. More effective therapies are needed for high-risk ACC recurrences. |
| first_indexed | 2024-04-11T03:33:26Z |
| format | Article |
| id | doaj.art-6e86a031af534115af185c70e19439bc |
| institution | Directory Open Access Journal |
| issn | 1916-0216 |
| language | English |
| last_indexed | 2024-04-11T03:33:26Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj.art-6e86a031af534115af185c70e19439bc2023-01-02T05:54:18ZengBMCJournal of Otolaryngology - Head and Neck Surgery1916-02162018-04-014711710.1186/s40463-018-0273-zMortality risk after clinical management of recurrent and metastatic adenoid cystic carcinomaMelody J. Xu0Tara J. Wu1Annemieke van Zante2Ivan H. El-Sayed3Alain P. Algazi4William R. Ryan5Patrick K. Ha6Sue S. Yom7Department of Radiation Oncology, University of California San FranciscoDepartment of Head and Neck Surgery, University of California Los AngelesDepartment of Pathology, University of California San FranciscoDivision of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San FranciscoDepartment of Medicine, University of California San FranciscoDivision of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San FranciscoDivision of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San FranciscoDepartment of Radiation Oncology, University of California San FranciscoAbstract Background Management of locoregional recurrence (LRR) and distant metastasis (DM) in adenoid cystic carcinoma (ACC) is guided by limited data. We investigated mortality risks in patients diagnosed and treated for recurrent ACC. Methods A retrospective review of ACC patients treated from 1989 to 2016 identified 36 patients with LRR or DM. High-risk disease was defined as skull base involvement (for LRR) or International Registry of Lung Metastases Group III/IV or extrapulmonary site of metastasis (for DM). Kaplan-Meier method, log-rank tests, and Cox proportional hazards were used for time-to-event analysis. Results Among 20 LRR and 16 DM patients, the median times to recurrence were 51 and 50 months, respectively. The median follow-up post-recurrence was 37.5 months (interquartile range (IQR)16.5–56.5). Post-recurrence 3-year overall survival (OS) was 78.5%, 73.3% for LRR and 85.1% for DM (p = 0.62). High-risk recurrences were associated with worse 3-year OS (68.8% for high-risk and 92.3% for low-risk, χ2 = 10.4, p = 0.001). Among LRR patients, 90% had surgery as part of their treatment. Multimodality therapy, age, and histopathologic features (size, margins, solid histology, lymphovascular or perineural invasion) were not associated with PFS or OS. High-risk LRR was the only variable associated with OS (χ2 = 5.9, p = 0.01). Among DM patients, six were initially managed with observation and ten received surgery, RT, or systemic therapy. Upfront therapy was not associated with improved PFS or OS. High-risk DM was the only variable associated with OS (χ2 = 4.7, p = 0.03). Conclusions High-risk LRR and DM were associated with decreased 3-year OS. More effective therapies are needed for high-risk ACC recurrences.http://link.springer.com/article/10.1186/s40463-018-0273-zAdenoid cystic carcinomaRecurrenceSkull baseLung metastasesSurvival |
| spellingShingle | Melody J. Xu Tara J. Wu Annemieke van Zante Ivan H. El-Sayed Alain P. Algazi William R. Ryan Patrick K. Ha Sue S. Yom Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma Journal of Otolaryngology - Head and Neck Surgery Adenoid cystic carcinoma Recurrence Skull base Lung metastases Survival |
| title | Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma |
| title_full | Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma |
| title_fullStr | Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma |
| title_full_unstemmed | Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma |
| title_short | Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma |
| title_sort | mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma |
| topic | Adenoid cystic carcinoma Recurrence Skull base Lung metastases Survival |
| url | http://link.springer.com/article/10.1186/s40463-018-0273-z |
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