title: Defining the surgical margins of adenoid cystic carcinoma and their impact on outcome: An international collaborative study.
abstract: The mainstay of treatment in adenoid cystic carcinoma (ACC) of the head and neck is surgical resection with negative margins. The purpose of this study was to define the margin status that associates with survival outcomes of ACC of the head and neck.
  
  
  
  We conducted univariate and multivariate analyses of international data.
  
  
  
  Data of 507 patients with ACC of the head and neck were analyzed; negative margins defined as ≥5 mm were detected in 253 patients (50%). On multivariate analysis, the hazard ratios (HRs) of positive margin status were 2.68 (95% confidence interval [CI], 1.2-6.2; p = .04) and 2.63 (95% CI, 1.1-6.3; p = .03) for overall survival (OS) and disease-specific survival (DSS), respectively. Close margins had no significant impact on outcome, with HRs of 1.1 (95% CI, 0.4-3.0; p = .12) and 1.07 (95% CI, 0.3-3.4; p = .23) for OS and DSS, respectively, relative with negative margins.
  
  
  
  In head and neck ACC, positive margins are associated with the worst outcome. Negative or close margins are associated with improved outcome, regardless of the distance from the tumor. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1008-1014, 2017.
authors.affiliation: The Head and Neck Center, Department of Otolaryngology - Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.|The Clinical Research Institute at Rambam, Rambam Medical Center, Rappaport Faculty of Medicine and Research Institute, The Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Amit
authors.affiliation: The Head and Neck Center, Department of Otolaryngology - Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.|The Clinical Research Institute at Rambam, Rambam Medical Center, Rappaport Faculty of Medicine and Research Institute, The Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Shorook
authors.initials: S
authors.lastname: Na'ara
authors.affiliation: Department of Pathology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Leonor
authors.initials: L
authors.lastname: Trejo-Leider
authors.affiliation: Department of Pathology, The Mount Sinai School of Medicine, New York, New York.
authors.forename: Naomi
authors.initials: N
authors.lastname: Ramer
authors.affiliation: Department of Pathology, The Mount Sinai School of Medicine, New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: Burstein
authors.affiliation: Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York.
authors.forename: Ma
authors.initials: M
authors.lastname: Yue
authors.affiliation: Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York.
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, People's Republic of 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, People's Republic of China.
authors.forename: Delin
authors.initials: D
authors.lastname: Lei
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Odense University Hospital Denmark, Denmark, Germany.
authors.forename: Kristine
authors.initials: K
authors.lastname: Bjoerndal
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Odense University Hospital Denmark, Denmark, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Godballe
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: André M
authors.initials: AM
authors.lastname: Eckardt
authors.affiliation: Department of Maxillofacial Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Copelli
authors.affiliation: Department of Maxillofacial Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Sesenna
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Snehal
authors.initials: S
authors.lastname: Patel
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.affiliation: The Head and Neck Center, Department of Otolaryngology - Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.|The Clinical Research Institute at Rambam, Rambam Medical Center, Rappaport Faculty of Medicine and Research Institute, The Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Gil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003528:Carcinoma, Adenoid Cystic / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: adenoid cystic carcinoma; head and neck cancer; margins; oral cavity; paranasal sinuses; salivary gland; survival