Head and neck adenoid cystic carcinoma: A prospective multicenter REFCOR study of 95 cases.
OBJECTIVE
To describe the clinical, histological and therapeutic characteristics of a prospective multicenter series of 95 head and neck adenoid cystic carcinoma patients, and to determine any prognostic factors for disease-free survival.


METHODS
Ninety-five patients with adenoid cystic carcinoma were included in the Réseau d'Expertise Français Des Cancers ORL Rares (REFCOR, French Rare Head and Neck Cancer Expert Network) database between 2009 and 2012. The primary site was the salivary glands in 39 cases, sinus cavities (including hard palate) in 36 cases, pharynx-larynx-trachea in 14 cases, and lips and oral cavity in 4 cases. The tumor was stage I in 15% of cases, stage II in 23%, stage III in 26% and stage IV in 36%. Nine patients had cervical lymph node involvement and 5 had metastases at diagnosis. Fifty-six percent of patients were managed by surgery with postoperative radiation therapy. During follow-up, 3 patients died, 9 developed metastases and 12 showed recurrence or local progression.


RESULTS
Mean follow-up was 18 months. On univariate analysis, disease-free survival correlated with T stage (P=0.05), N stage (P=0.003), resection margins (P=0.04), lymph node involvement on histology (P=0.01), and absence of chemotherapy (P=0.03). On multivariate analysis, disease-free survival correlated with T stage (P=0.01), N stage (P=0.09) and surgery (P=0.005).


CONCLUSIONS
The essential issue in adenoid cystic carcinoma is long-term control. The present results confirm that the reference attitude is radical surgical resection for optimal local control. Adjuvant radiation therapy did not emerge as a prognostic factor. This study also provides a starting-point for translational studies in pathology and genetics.
Service ORL-CCF, hôpital Foch, 40, rue Worth, 92151 Suresnes, France; Service ORL-CCF, hôpital Tenon, université Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France.
M
M
Meyers
Service de santé publique et biostatistiques, hôpital Pitié Salpétrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris, France.
B
B
Granger
Service ORL-CCF, hôpital Lariboisière, université Paris VII, AP-HP, 2, rue Ambroise-Paré, 75475 Paris, France.
P
P
Herman
Département ORL-CCF, institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
F
F
Janot
Service ORL-CCF, hôpital Gui-de-Chauliac, université de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
R
R
Garrel
Service ORL-CCF, hôpital la Timone, université de Marseille, 264, rue Saint-Pierre, 13385 Marseille, France.
N
N
Fakhry
Service ORL-CCF, centre Lacassagne, 33, avenue Valombrose, 06100 Nice, France.
G
G
Poissonnet
Service ORL-CCF, hôpital Tenon, université Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: bertrand.baujat@tnn.aphp.fr.
B
B
Baujat
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003528:Carcinoma, Adenoid Cystic / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D055815:Young Adult
Adenoid cystic carcinoma; Prognostic factors; Salivary glands