- •Head and neck adenoid cystic carcinoma occur more frequently in women (sex ratio: 1.5).
- •Age, body mass index and N stage are the three main clinical prognostic factors influencing event-free survival.
- •Tumour size, perineural invasion and the presence of histological grade III also have a negative influence on prognosis.
Adenoid cystic carcinoma (ACC) accounts for 1% of malignant head and neck tumours  and 10% of salivary glands malignant tumours. The main objective of our study is to investigate the prognostic factors influencing the event-free survival (EFS) of patients with ACC.
Patients and methods
A multicentre prospective study was conducted from 2009 to 2018. All 470 patients with ACC whose survival data appear in the REFCOR database were included in the study. The main judgement criterion was EFS. Both a bivariate survival analysis using log-rank test and a multivariate using Cox model were performed using the R software.
Average age was 55 years. Females accounted for 59.4% of the cohort. The body mass index (BMI) was normal in 86% of cases. Tumours were located in minor salivary glands in 60% of cases. T3/T4 stages represented 58%; 89% of patients were cN0. histological grade III was observed on 21% of patients. The EFS and overall 5-year survival rates were 50% and 85%, respectively. After adjustment, the most significant pejorative prognostic factors were age ≥65 years (hazard ratio [HR] = 1.67), BMI<16.5 (HR = 2.62), and lymph node invasion cN (HR = 2.08).
Age, BMI and N stage are the three main clinical prognostic factors determining EFS identified in this prospective series of patients with ACC. Such findings open new research perspectives on the influence of these components on initial patient care.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Cancer
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Adenoid cystic carcinoma of salivary origin. A clinicopathologic study of 242 cases.Am J Surg. 1974; 128: 512-520
- Cancer Incidence in Five Continents: inclusion criteria, highlights from Volume X and the global status of cancer registration.Int J Canc. 2015; 137: 2060-2071https://doi.org/10.1002/ijc.29670
- Survival from salivary glands adenoid cystic carcinoma in European populations.Oral Oncol. 2009; 45: 669-674https://doi.org/10.1016/j.oraloncology.2008.10.010
- Adenoid cystic carcinoma of the head and neck: a review.Curr Opin Otolaryngol Head Neck Surg. 2004; 12: 127-132
- Clinicopathological characteristics and perineural invasion in adenoid cystic carcinoma: a systematic review.Braz J Otorhinolaryngol. 2015; 81: 329-335https://doi.org/10.1016/j.bjorl.2014.07.016
- Adenoid cystic carcinoma of the head and neck-An update.Oral Oncol. 2015; 51: 652-661https://doi.org/10.1016/j.oraloncology.2015.04.005
- Update from the 4th edition of the World Health organization classification of head and neck tumours: tumours of the salivary gland.Head Neck Pathol. 2017; 11: 55-67https://doi.org/10.1007/s12105-017-0795-0
- Risk factors and prognosis for salivary gland adenoid cystic carcinoma in southern China: a 25-year retrospective study.Medicine (Baltim). 2017; 96: 5964-5974https://doi.org/10.1097/MD.0000000000005964
- Nomograms for predicting survival and recurrence in patients with adenoid cystic carcinoma. An international collaborative study.Eur J Cancer Oxf Engl. 1990 2015; 51: 2768-2776https://doi.org/10.1016/j.ejca.2015.09.004
- Analysis of failure in patients with adenoid cystic carcinoma of the head and neck. An international collaborative study.Head Neck. 2014; 36: 998-1004https://doi.org/10.1002/hed.23405
- Clinical outcomes and prognostic factors of salivary gland adenoid cystic carcinomas: a case control study.Oral Surg Oral Med Oral Pathol Oral Radiol. 2017; 123: 531-535https://doi.org/10.1016/j.oooo.2016.11.015
- Incidence of adenoid cystic carcinoma in nova scotia: 30-year population-based epidemiologic study.J Otolaryngol - Head Neck Surg J Oto-Rhino-Laryngol Chir Cervico-Faciale. 2008; 37: 642-648
- Model to predict cause-specific mortality in patients with head and neck adenoid cystic carcinoma: a competing risk analysis.Ann Surg Oncol. 2017; 24: 2129-2136https://doi.org/10.1245/s10434-017-5861-z
- Adenoid cystic carcinoma of the head and neck: incidence and survival trends based on 1973-2007 Surveillance, Epidemiology, and End Results data.Cancer. 2012; 118: 4444-4451https://doi.org/10.1002/cncr.27408
- Determinants and patterns of survival in adenoid cystic carcinoma of the head and neck, including an analysis of adjuvant radiation therapy.Am J Clin Oncol. 2011; 34: 76-81https://doi.org/10.1097/COC.0b013e3181d26d45
- A comparison of the demographics, clinical features, and survival of patients with adenoid cystic carcinoma of major and minor salivary glands versus less common sites within the Surveillance, Epidemiology, and End Results registry.Cancer. 2012; 118: 3945-3953https://doi.org/10.1002/cncr.26740
- Rare tumorus of the head and neck; on behalf of the REFCOR, the French Network of rare head and neck tumorus.Bull Cancer (Paris). 2014; 101: 411-423https://doi.org/10.1684/bdc.2014.1956
- Head and neck adenoid cystic carcinoma: a prospective multicenter REFCOR study of 95 cases.Eur Ann Otorhinolaryngol Head Neck Dis. 2016; 133: 13-17https://doi.org/10.1016/j.anorl.2015.09.009
- Pathologists and the French network of expertise on rare cancers ENT: the REFCORpath.Ann Pathol. 2014; 34: 64-69https://doi.org/10.1016/j.annpat.2014.01.006
- Clinicopathologic predictors of recurrence and overall survival in adenoid cystic carcinoma of the head and neck: a single institutional experience at a tertiary care center.Head Neck. 2014; 36: 1705-1711https://doi.org/10.1002/hed.23523
- Salivary adenoid cystic carcinoma in Denmark 1990-2005: outcome and independent prognostic factors including the benefit of radiotherapy. Results of the Danish Head and Neck Cancer Group (DAHANCA).Oral Oncol. 2015; 51: 1138-1142https://doi.org/10.1016/j.oraloncology.2015.10.002
- Adenoid cystic carcinoma of the head and neck.Am J Otolaryngol. 2012; 33: 510-518https://doi.org/10.1016/j.amjoto.2011.11.006
- Sinonasal adenoid cystic carcinomas: clinical outcomes and predictive factors.Int J Oral Maxillofac Surg. 2013; 42: 153-157https://doi.org/10.1016/j.ijom.2012.11.007
- Cervical lymph node metastasis in adenoid cystic carcinoma of the major salivary glands.J Laryngol Otol. 2017; 131: 96-105https://doi.org/10.1017/S0022215116009749
- Cervical lymph node metastasis in adenoid cystic carcinoma of the sinonasal tract, nasopharynx, lacrimal glands and external auditory canal: a collective international review.J Laryngol Otol. 2016; 130: 1093-1097https://doi.org/10.1017/S0022215116009373
- Adenoid cystic carcinoma of the head and neck: a single-center analysis of 105 consecutive cases over a 30-year period.Oral Oncol. 2013; 49: 824-829https://doi.org/10.1016/j.oraloncology.2013.05.004
- Adenoid cystic carcinoma of the head and neck-a 20 year's experience.Int J Oral Maxillofac Surg. 2004; 33: 25-31https://doi.org/10.1054/ijom.2003.0448
- Adenoid cystic carcinoma of the head and neck treated by surgery with or without postoperative radiation therapy: prognostic features of recurrence.Int J Radiat Oncol Biol Phys. 2006; 66: 152-159https://doi.org/10.1016/j.ijrobp.2006.04.014
- Adenoid cystic carcinoma: a retrospective clinical review.Int J Canc. 2001; 96: 149-158
- Cervico-facial adenoid cystic carcinoma: study of 102 cases. Influence of radiation therapy.Int J Radiat Oncol Biol Phys. 1987; 13: 673-678
- Outcomes and prognostic variables in adenoid cystic carcinoma of the head and neck: a recent experience.Int J Radiat Oncol Biol Phys. 2008; 70: 1365-1372https://doi.org/10.1016/j.ijrobp.2007.08.008
- Adenoid cystic carcinoma of the head and neck: predictors of morbidity and mortality.Arch Otolaryngol Head Neck Surg. 1999; 125: 149-152
- Patterns of recurrence and survival of head and neck adenoid cystic carcinoma after definitive resection.Laryngoscope. 2010; 120: 65-70https://doi.org/10.1002/lary.20684
- Adenoid cystic salivary gland carcinoma. A histopathologic review of treatment failure patterns.Cancer. 1986; 57: 519-524
- Stage means more than grade in adenoid cystic carcinoma.Am J Surg. 1992; 164: 623-628https://doi.org/10.1016/s0002-9610(05)80721-4
- The Simpson's paradox unraveled.Int J Epidemiol. 2011; 40: 780-785https://doi.org/10.1093/ije/dyr041
- Diffuse staining for activated NOTCH1 correlates with NOTCH1 mutation status and is associated with worse outcome in adenoid cystic carcinoma.Am J Surg Pathol. 2017; 41: 1473-1482https://doi.org/10.1097/PAS.0000000000000945
- Comprehensive analysis of the MYB-NFIB gene fusion in salivary adenoid cystic carcinoma: incidence, variability, and clinicopathologic significance.Clin Cancer Res Off J Am Assoc Cancer Res. 2010; 16: 4722-4731https://doi.org/10.1158/1078-0432.CCR-10-0463
Published online: March 11, 2020
Accepted: January 28, 2020
Received in revised form: January 14, 2020
Received: September 29, 2019
© 2020 Elsevier Ltd. All rights reserved.