Virchows Arch DOI 10.1007/s00428-015-1760-5
ORIGINAL ARTICLE
Pattern of recurrent disease in major salivary gland adenocystic carcinoma Karoliina Hirvonen 1 & Leif Bäck 1 & Kauko Saarilahti 2 & Ilmo Leivo 3,4 & Jaana Hagström 3 & Antti A. Mäkitie 1,5
Received: 15 December 2014 / Revised: 23 February 2015 / Accepted: 11 March 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract This study aims to evaluate the long-term outcome of major salivary gland adenocystic carcinoma (ACC). This is a retrospective review of 54 cases of ACC during a 35-year period from 1974 to 2009 at the Helsinki University Central Hospital, Helsinki, Finland. Medical records and histological samples were reviewed. All patients had a minimum followup time of 5 years or until death. Most of the tumours occurred in the parotid gland (n=30, 56 %) followed by submandibular gland (n=22, 41 %) and sublingual gland (n=2, 4 %). Fiftytwo patients (96 %) were treated with curative intent. All of these patients except one were primarily treated with surgery, and 29 patients (54 %) also received postoperative radiotherapy for their primary tumour. Two patients (4 %) received palliative radiotherapy. For those treated with curative intent, 32 patients (62 %) had disease recurrence. Twenty-four
patients (75 %) had their first disease recurrence within 5 years and eight patients (25 %) later than 5 years. The difference in the length of recurrence-free time interval (5 years) had a significant impact on 5-year overall survival (OS) and disease-specific survival (DSS). The OS, DSS and diseasefree survival (DFS) across stages I–IV varied between 46– 100, 50–100 and 46–100 %, respectively. Age over 45 years, T stage, and presence of neck metastases had a significant negative prognostic effect. More than half of the patients had recurrent disease. An extended follow-up for these patients seems feasible as most of the distant metastases were detected within a 10-year period.
Keywords Head and neck . Malignancy . Surgery . Radiation . Survival
Introduction * Karoliina Hirvonen [email protected] 1
Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, HUCH, P.O.Box 220, FI-00029 Helsinki, Finland
2
Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3
Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
4
Department of Pathology, University of Turku, Turku, Finland
5
Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Salivary gland carcinoma (SGC) is a rare entity comprising approximately 4 % of all head and neck malignancies [1]. According to the Finnish Cancer Registry (2007–2011), there are annually approximately 60 new cases of SGC in Finland with a population of 5.3 million. The corresponding ageadjusted incidence rates during the years 2007–2011 were 0.7 for males and 0.6 for females per 100,000 person-years (www.cancer.fi). According to the latest WHO classification (2005), SGCs are divided into 24 subtypes [2]. In some studies, mucoepidermoid carcinoma (MEC) is the most common histologic subtype followed by adenocystic carcinoma (ACC) [3, 4]. Luukkaa et al. reviewed a national series of 237 SGCs in Finland between 1991 and 1996 and found ACC as the most
Virchows Arch
common subtype (27 %), followed by MEC (19 %) and acinic cell carcinoma (17 %) [5]. ACC is divided into cribriform, tubular and solid histologic subtypes. Cribriform is the most common type including approximately 40 % of these carcinomas. Tubular subtype has the best prognosis, whereas the solid type, which is the rarest (approximately 20 % of ACC), is known to be the most aggressive and also an independent prognostic factor for metastases [1, 6]. The recommended primary treatment for ACC is surgery, followed by radiotherapy in selected cases. Many centres have reported increased survival outcome with combined surgery and radiotherapy compared with surgery alone [7, 8]. Balamucki et al. compared radiotherapy alone with combined surgery and radiotherapy and found 10-year local control rates of 36 and 84 %, respectively (p=
ORIGINAL ARTICLE
Pattern of recurrent disease in major salivary gland adenocystic carcinoma Karoliina Hirvonen 1 & Leif Bäck 1 & Kauko Saarilahti 2 & Ilmo Leivo 3,4 & Jaana Hagström 3 & Antti A. Mäkitie 1,5
Received: 15 December 2014 / Revised: 23 February 2015 / Accepted: 11 March 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract This study aims to evaluate the long-term outcome of major salivary gland adenocystic carcinoma (ACC). This is a retrospective review of 54 cases of ACC during a 35-year period from 1974 to 2009 at the Helsinki University Central Hospital, Helsinki, Finland. Medical records and histological samples were reviewed. All patients had a minimum followup time of 5 years or until death. Most of the tumours occurred in the parotid gland (n=30, 56 %) followed by submandibular gland (n=22, 41 %) and sublingual gland (n=2, 4 %). Fiftytwo patients (96 %) were treated with curative intent. All of these patients except one were primarily treated with surgery, and 29 patients (54 %) also received postoperative radiotherapy for their primary tumour. Two patients (4 %) received palliative radiotherapy. For those treated with curative intent, 32 patients (62 %) had disease recurrence. Twenty-four
patients (75 %) had their first disease recurrence within 5 years and eight patients (25 %) later than 5 years. The difference in the length of recurrence-free time interval (5 years) had a significant impact on 5-year overall survival (OS) and disease-specific survival (DSS). The OS, DSS and diseasefree survival (DFS) across stages I–IV varied between 46– 100, 50–100 and 46–100 %, respectively. Age over 45 years, T stage, and presence of neck metastases had a significant negative prognostic effect. More than half of the patients had recurrent disease. An extended follow-up for these patients seems feasible as most of the distant metastases were detected within a 10-year period.
Keywords Head and neck . Malignancy . Surgery . Radiation . Survival
Introduction * Karoliina Hirvonen [email protected] 1
Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, HUCH, P.O.Box 220, FI-00029 Helsinki, Finland
2
Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3
Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
4
Department of Pathology, University of Turku, Turku, Finland
5
Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Salivary gland carcinoma (SGC) is a rare entity comprising approximately 4 % of all head and neck malignancies [1]. According to the Finnish Cancer Registry (2007–2011), there are annually approximately 60 new cases of SGC in Finland with a population of 5.3 million. The corresponding ageadjusted incidence rates during the years 2007–2011 were 0.7 for males and 0.6 for females per 100,000 person-years (www.cancer.fi). According to the latest WHO classification (2005), SGCs are divided into 24 subtypes [2]. In some studies, mucoepidermoid carcinoma (MEC) is the most common histologic subtype followed by adenocystic carcinoma (ACC) [3, 4]. Luukkaa et al. reviewed a national series of 237 SGCs in Finland between 1991 and 1996 and found ACC as the most
Virchows Arch
common subtype (27 %), followed by MEC (19 %) and acinic cell carcinoma (17 %) [5]. ACC is divided into cribriform, tubular and solid histologic subtypes. Cribriform is the most common type including approximately 40 % of these carcinomas. Tubular subtype has the best prognosis, whereas the solid type, which is the rarest (approximately 20 % of ACC), is known to be the most aggressive and also an independent prognostic factor for metastases [1, 6]. The recommended primary treatment for ACC is surgery, followed by radiotherapy in selected cases. Many centres have reported increased survival outcome with combined surgery and radiotherapy compared with surgery alone [7, 8]. Balamucki et al. compared radiotherapy alone with combined surgery and radiotherapy and found 10-year local control rates of 36 and 84 %, respectively (p=
