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Factors influencing survival in acinic cell carcinoma: A retrospective survival analysis of 2061 patients: Surviving Acinic Cell Carcinoma ARTICLE in HEAD & NECK · JULY 2014 Impact Factor: 3.01 · DOI: 10.1002/hed.23686
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Factors Influencing Survival in Acinic Cell Carcinoma: A Retrospective Survival Analysis of 2,061 Patients Vincent L. Biron, MD, PhD1, Eric J. Lentsch, MD2, Daniel R. Gerry, BSc2,3 and Arnaud F. Bewley, MD1 1University of California Davis, Department of Otolaryngology, Sacramento, California. 2Medical University of South Carolina, Department of Otolaryngology‐Head and Neck
Surgery, Charleston, South Carolina. 3Mercer University School of Medicine, Savannah, GA. *Corresponding Author/Reprint Requests: Arnaud F. Bewley, MD Assistant Professor University of California Davis Health System Department of Otolaryngology 2521 Stockton Blvd, Suite 7200 Sacramento, CA 95817 Email:
[email protected] This material has never been published. Abstract from this manuscript has been submitted for presentation at the 2014 Multidisciplinary Head and Neck Cancer Symposium, Scottsdale, Arizona, February 20-22, 2014. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as an ‘Accepted Article’, doi: 10.1002/hed.23686
Biron, Gerry, Lentsch and Bewley: Survival of Acinic Cell Carcinoma Abstract: Background: Acinic cell carcinoma (AciCC) is an uncommon salivary neoplasm with clinical and histologic features known to influence prognosis. The goal of this study is to further describe variables influencing survival in a large cohort of patients with AciCC. Methods: Using the SEER registry, we obtained demographic, clinicopathologic and treatment data pertaining to patients diagnosed with AciCC. Kaplan‐Meir and Cox‐regression analyses were performed to compare survival with various clinical and pathological parameters. Results: We identified 2,061 patients with AciCC from 1973‐2009. Gender, staging, grade, subsite and treatment were significant predictors of disease specific survival (DSS). Patients who received surgery alone had the highest 20‐year DSS (92.4 %), followed by those treated with surgery and radiation (71.9%) or radiation alone (62.3 %). Conclusions: Our results suggest that histologic grade is a stronger predictor of survival than TNM stage, survival following surgical resection alone is excellent, and adjuvant radiation may be of limited benefit.
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Biron, Gerry, Lentsch and Bewley: Survival of Acinic Cell Carcinoma Introduction: Acinic Cell Carcinoma (AciCC) is a slow‐growing salivary gland neoplasm most commonly affecting the parotid gland1‐3. A diagnosis of AciCC generally portends a favorable long‐ term prognosis with 20‐year disease specific survival (DSS) estimates approaching 90%1. Nevertheless, a proportion of patients are faced with aggressive and fatal disease. In some cases, this may be due to delayed diagnosis given the asymptomatic nature of early stage disease. Alternatively, some patients have more aggressive histopathologic subtypes, which have been shown to impact survival outcomes1,4. Despite several consistent reports on the demographics and epidemiology of AciCC, the roles of surgery and radiation in the management of these tumors remains unclear1. Primary surgical excision has been the mainstay of management for these tumors for several years but controversy exists with regards to the use of post‐operative radiotherapy5,6. To date, there is a paucity of studies investigating the survival advantage of post‐operative radiation in AciCC. Nevertheless, radiation is often used for patients with advanced stage disease, positive resection margins or positive lymph nodes2,7,8. A recent study by Patel et al. reported demographic and survival trends in 1,129 cases of AciCC in the United States, representing the largest population‐based study of this neoplasm to date1. Their study provided significant evidence that survival is influenced by gender, histologic grade, race and extent of disease. However, this study was limited to
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Biron, Gerry, Lentsch and Bewley: Survival of Acinic Cell Carcinoma major salivary gland AciCC subsites, did not compare histologic grade to TNM staging and did not include an analysis of treatment differences. To expand on this study, we performed an extended population‐based analysis using the SEER database. Based on current literature, we hypothesized that 1) histologic grade is a stronger predictor of survival than TNM stage, and 2) patients receiving surgical treatment alone have excellent survival outcomes. The primary objective of this study was therefore to compare how survival outcomes of patients with AciCC correlate with TNM staging, histologic grading and different treatment modalities (surgery vs surgery and radiation vs radiation). A secondary objective was to compare survival of major vs minor salivary gland AciCC. Materials and Methods: Data was obtained from the SEER registry in a similar fashion to recent similar studies1,9,10. We retrieved both minor and major salivary gland subsite tumors with the histological diagnosis of AciCC, including parotid, submandibular, sublingual glands and tumors of the oral cavity, oropharynx, hypopharynx, larynx, trachea and sinonasal cavity. Staging information extracted from the SEER database was categorized according to recent AJCC staging11,12. Patients were stratified according to subsite, race, gender, age and year at diagnosis, T‐classification, N‐classification, M‐classification, TNM stage, histological grade and treatment modality. Survival time was calculated in years from time of pathologic diagnosis to date last known alive or date of death using a right censoring method. Cause of death was classified as either cause‐specific (disease specific) or other cause.
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Biron, Gerry, Lentsch and Bewley: Survival of Acinic Cell Carcinoma SPSS version 21.0 was used for all statistical analyses (SPSS Inc., Chicaco, IL, USA). The Kaplan‐Meir algorithm was used to calculate overall and disease specific survival, employing the Log‐rank test to make pairwise comparisons between strata, with statistical significance denoted for p