title: Adenoid cystic carcinoma of the head and neck: a single-center analysis of 105 consecutive cases over a 30-year period.
abstract: BACKGROUND
  Adenoid cystic carcinoma is a rare salivary gland malignancy with a poor disease free survival due to frequent distant metastases and late local recurrences. Previous single-center reports on outcome mostly encompass small series. In this report a relative large series of 105 cases is analyzed, all treated at the VU University Medical Center, Amsterdam, The Netherlands over a 30-year period in which treatment strategies remained unchanged.
  
  
  METHODS
  All cases of ACC of the head and neck between 1979 and 2009 at our institution were analyzed through a medical chart review. Recurrence patterns and possible prognostic factors (T-stage, N-status, age, gender, type of salivary gland involved, histological grade, surgical margins, perineural invasion (PNI) and postoperative radiotherapy (RT)) were analyzed.
  
  
  RESULTS
  One-hundred and five cases of ACC of the head and neck were identified. Five-, ten- and twenty-year survival rates for overall survival were 68%, 52% and 28%, respectively. T-stage, N-status, surgical margins, histological subtype and age were highly significant predictors for survival. PNI was not a negative prognosticator.
  
  
  CONCLUSIONS
  T-stage, N-status, surgical margins, histological grade and age are the main predictors of survival-outcome in ACC of the head and neck. Distant metastasis frequently develop, mainly in the first 5 years post treatment. Local recurrences often develop even later on, warranting long term follow up of patients treated for ACC. Grade III ACC should be considered a specific entity within the group of ACC due to its typical aggressive biological behavior and relatively poor outcome, implicating the need for an improved adjuvant treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. s.vanweert@vumc.nl
authors.forename: Stijn
authors.initials: S
authors.lastname: van Weert
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bloemena
authors.forename: Isaäc
authors.initials: I
authors.lastname: van der Waal
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.forename: Derek H F
authors.initials: DH
authors.lastname: Rietveld
authors.forename: Joop D
authors.initials: JD
authors.lastname: Kuik
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003528:Carcinoma, Adenoid Cystic / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D055815:Young Adult
keywords: Adenoid cystic carcinoma; Histology; Prognosticator; Surgical margins; Survival; Tumor stage