title: Nomograms for predicting survival and recurrence in patients with adenoid cystic carcinoma. An international collaborative study.
abstract: BACKGROUND
  Due to the rarity of adenoid cystic carcinoma (ACC), information on outcome is based upon small retrospective case series. The aim of our study was to create a large multiinstitutional international dataset of patients with ACC in order to design predictive nomograms for outcome.
  
  
  METHODS
  ACC patients managed at 10 international centers were identified. Patient, tumor, and treatment characteristics were recorded and an international collaborative dataset created. Multivariable competing risk models were then built to predict the 10 year recurrence free probability (RFP), distant recurrence free probability (DRFP), overall survival (OS) and cancer specific mortality (CSM). All predictors of interest were added in the starting full models before selection, including age, gender, tumor site, clinical T stage, perineural invasion, margin status, pathologic N-status, and M-status. Stepdown method was used in model selection to choose predictive variables. An external dataset of 99 patients from 2 other institutions was used to validate the nomograms.
  
  
  RESULTS
  Of 438 ACC patients, 27.2% (119/438) died from ACC and 38.8% (170/438) died of other causes. Median follow-up was 56 months (range 1-306). The nomogram for OS had 7 variables (age, gender, clinical T stage, tumor site, margin status, pathologic N-status and M-status) with a concordance index (CI) of 0.71. The nomogram for CSM had the same variables, except margin status, with a concordance index (CI) of 0.70. The nomogram for RFP had 7 variables (age, gender, clinical T stage, tumor site, margin status, pathologic N status and perineural invasion) (CI 0.66). The nomogram for DRFP had 6 variables (gender, clinical T stage, tumor site, pathologic N-status, perineural invasion and margin status) (CI 0.64). Concordance index for the external validation set were 0.76, 0.72, 0.67 and 0.70 respectively.
  
  
  CONCLUSIONS
  Using an international collaborative database we have created the first nomograms which estimate outcome in individual patients with ACC. These predictive nomograms will facilitate patient counseling in terms of prognosis and subsequent clinical follow-up. They will also identify high risk patients who may benefit from clinical trials on new targeted therapies for patients with ACC.
  
  
  BACKGROUND
  None.
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: ganlyi@mskcc.org.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.affiliation: The Laboratory for Applied Cancer Research, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Amit
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Kou
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Palmer
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Migliacci
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Katabi
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
authors.forename: Changhong
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authors.lastname: Yu
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.affiliation: The Laboratory for Applied Cancer Research, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Binenbaum
authors.affiliation: Department of Radiotherapy & Oncology, Maulana Azad Medical College and Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, India.
authors.forename: Kanika
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Mount Sinai Medical Center, Department of Pathology, The Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Ramer
authors.initials: R
authors.lastname: Naomi
authors.affiliation: Department of Otolaryngology, The Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Agbetoba
authors.initials: A
authors.lastname: Abib
authors.affiliation: Department of Otolaryngology, The Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Miles
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, PR China.
authors.forename: Xinjie
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, PR China.
authors.forename: Delin
authors.initials: D
authors.lastname: Lei
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Denmark.
authors.forename: Kristine
authors.initials: K
authors.lastname: Bjoerndal
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Godballe
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Fliss
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: André M
authors.initials: AM
authors.lastname: Eckardt
authors.affiliation: Maxillo-Facial Surgery, University-Hospital of Parma, Italy.
authors.forename: Copelli
authors.initials: C
authors.lastname: Chiara
authors.affiliation: Maxillo-Facial Surgery, University-Hospital of Parma, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Sesenna
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Edinburgh, UK.
authors.forename: Safina
authors.initials: S
authors.lastname: Ali
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Canada.
authors.forename: Lukas
authors.initials: L
authors.lastname: Czerwonka
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: The Laboratory for Applied Cancer Research, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel; Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Gil
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003528:Carcinoma, Adenoid Cystic / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003299:Cooperative Behavior; D003661:Decision Support Techniques; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D049451:Nomograms; D018579:Patient Selection; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adenoid cystic cancer; Nomogram