Highlights
- •The incidence of occult lymph node metastases is low in head and neck adenoid cystic carcinoma (5%).
- •They are mainly found when tumours infiltrate of the oral cavity mucosa (6/7 cases).
- •Given a close preoperative assessment, prophylactic neck dissection should not be performed in cN0 patients.
Abstract
Background
Patterns of nodal involvement in adenoid cystic carcinoma (ACC) of the head and neck
have not been sufficiently assessed to guide a decision of prophylactic neck dissection
(ND). The objective of this study is to analyse the influence of ND on event-free
survival (EFS) for patients with cN0 ACC.
Patients and methods
A multicentre prospective study was conducted between 2009 and 2018. Patients presenting
cN0 non-metastatic ACC on any site, and who received surgery on the tumour, were included.
EFS was the main judgement criterion. A comparative survival analysis between the
groups that received a ND versus those that did not was performed, using a propensity
score. Analyses were carried out using the R software.
Results
Between 2009 and 2018, 322 patients with cN0 ACC were included, out of which 58% were
female. The average age was 53 years. Tumours were in minor salivary glands in 58%
of cases, and 52% had T3/T4 stages.
ND was performed on 46% of patients. Out of them, seven had histological lymph node
invasion, out of which six had tumour infiltration in the mucosa of oral cavity.
After propensity score, the median EFS for N0 patients with ND was 72 months (95%
Confidence Interval (CI) [48–81]), compared to 73 months (95% CI [52–85]) for patients
without ND (HR = 1.33; 95% CI [0.82–2.16]; p = 0.2).
Conclusion
ND of cN0 patients does not provide any benefit on EFS, which suggests that its application
on such patients is not necessary.
Keywords
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Article info
Publication history
Published online: January 30, 2020
Accepted:
December 26,
2019
Received in revised form:
November 17,
2019
Received:
September 29,
2019
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
