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The impact of clinicopathological factors on clinical outcomes in patients with salivary gland adenoid cystic carcinoma: a multi-institutional analysis in Japan

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Abstract

Background

Owing to the low incidence of adenoid cystic carcinoma (AdCC), reliable survival estimates and prognostic factors remained unclarified.

Methods

In this multi-institutional retrospective analysis, we collected 192 AdCC cases, and investigated the impact of clinicopathological factors on clinical outcomes of the patients. All AdCC cases were of salivary gland origin and were surgically treated with curative intent. Diagnoses of AdCC were validated by a central pathology review by expert pathologists.

Results

The 5-year overall survival (OS) and disease-free survival (DFS) rates were 92.5 and 50.0%, respectively. Treatment failure occurred in 89 patients (46%) with the distant failures in 65 (34%). Multivariate analysis indicated that pN2 and a pathologically positive surgical margin were independent prognostic factors for both OS and DFS. Histological grade III was an independent prognostic factor for OS. A primary site in the submandibular gland, pT3/4, pN1, and histological grade II were independent prognostic factors for DFS. Postoperative radiation therapy (PORT) improved the locoregional control (LRC) rate. Prophylactic neck dissection was not associated with a better OS or better LRC among patients with cN0. Facial nerve dissection did not improve clinical outcomes in parotid AdCC cases without facial nerve palsy.

Conclusions

A higher TN classification, a pathologically positive surgical margin, and a higher histological grade were associated with a lower OS. PORT improved LRC rates but neck dissection failed to improve clinical outcomes in patients with cN0. As the distant metastasis was frequent, effective systemic therapy is imperative to improve the survival of AdCC patients.

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Acknowledgements

This work was supported by grants-in-aid for scientific research, MEXT, Japan (no. 18H02633 to HI and 17K08746 to TM). The authors thank Drs. Ayako Masaki, Kana Tsuda, Yuma Sakamoto, Yoshihide Okumura, Kosuke Saida, and Yohei Ito, Nagoya City University for their valuable comments.

Author information

Author notes

  1. Daisuke Kawakita and Takayuki Murase contributed equally to this work.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Daisuke Kawakita & Takuma Matoba

  2. Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-ku, Nagoya, 467-8601, Japan

    Takayuki Murase, Kaori Ueda & Hiroshi Inagaki

  3. Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan

    Kaori Ueda & Toru Nagao

  4. Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Satoshi Kano

  5. Department of Head and Neck Oncology and Surgery, Mita Hospital, International University of Health and Welfare, Tokyo, Japan

    Yuichiro Tada

  6. Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan

    Kiyoaki Tsukahara

  7. Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan

    Kenji Okami

  8. Division of Head and Neck Surgery, Shizuoka Cancer Center, Mishima, Japan

    Tetsuro Onitsuka

  9. Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yasushi Fujimoto

  10. Department of Otorhinolaryngology, Fujita Health University, Toyoake, Japan

    Kazuo Sakurai

  11. Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan

    Nobuhiro Hanai

  12. Department of and Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Japan

    Ryo Kawata

  13. Department of Otolaryngology, Ehime University School of Medicine, Matsuyama, Japan

    Naohito Hato

  14. Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Ken-ichi Nibu

  15. Department of Diagnostic Pathology, School of Medicine, Fujita Health University, Toyoake, Japan

    Makoto Urano

  16. Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Ken-ichi Taguchi

  17. Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan

    Masato Nakaguro

  18. Department of Pathology, Shizuoka General Hospital, Shizuoka, Japan

    Kimihide Kusafuka

  19. Department of Anatomic Pathology, Graduate of School of Medical Science, Kyushu University, Fukuoka, Japan

    Hidetaka Yamamoto

  20. Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan

    Toshitaka Nagao

Authors
  1. Daisuke Kawakita
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  2. Takayuki Murase
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  3. Kaori Ueda
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  4. Satoshi Kano
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  10. Takuma Matoba
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  11. Kazuo Sakurai
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  16. Ken-ichi Nibu
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  18. Ken-ichi Taguchi
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  20. Kimihide Kusafuka
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  21. Hidetaka Yamamoto
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  22. Toshitaka Nagao
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  23. Hiroshi Inagaki
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Corresponding author

Correspondence to Hiroshi Inagaki.

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Conflict of interest

N Hanai received research grants from Chugai Pharmaceutical and Rakuten Medical. Other authors declare no conflicts of interest.

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Kawakita, D., Murase, T., Ueda, K. et al. The impact of clinicopathological factors on clinical outcomes in patients with salivary gland adenoid cystic carcinoma: a multi-institutional analysis in Japan. Int J Clin Oncol 25, 1774–1785 (2020). https://doi.org/10.1007/s10147-020-01731-9

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  • DOI: https://doi.org/10.1007/s10147-020-01731-9

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