Objectives: The biologic behavior of the adenoid cystic carcinoma (ACC) and the factors predicting outcome for these tumors are still poorly understood. Our objective is to analyze the predicting factors and the value...Objectives: The biologic behavior of the adenoid cystic carcinoma (ACC) and the factors predicting outcome for these tumors are still poorly understood. Our objective is to analyze the predicting factors and the value of different treatment possibilities, since none sole treatment has been standardized. Methods: A retrospective analysis of the epidemiologic, clinical and histologic aspects of ACC, as well as treatment options and other prognostic factors of all the cases of ACC of the head and neck treated at this Institution were analyzed. From 1974 until 2011, 152 patients were diagnosed with ACC and treated at the Portuguese Institute of Oncology (Porto Centre). Main outcome measures: overall survival, local recurrence and distant metastasis were calculated by the Kaplan-Meier method. Factors predictive of outcome were identified by univariate and multivariate analysis. Results: The mean age at diagnosis was 55.8 years (range, 19-83 years). Incidence was higher in the female population, with a female to male ratio of 1.7:1 respectively. The primary tumor location was hard palate and submandibular region in 56 cases, 28 in each location (24.6%), parotid gland (17 cases, 14.9%) and oral cavity excluding palate (16 cases, 14%).Distributions according to T stage were: T1 (29.8%);T2 (30.7%);T3 (17.5%);T4 (22%). The overall 1-year, 5-year and 10-year survival for all patients were 94.6%, 60.5%, 41.6%, respectively. Conclusions: Univariate survival analysis revealed that age older than 60 years (p = 0.002), solid histologic subtype (p = 0.042), advanced clinical stage (p p = 0.036) were correlated with a poor survival. Multivariate analysis confirmed that age and advanced clinical stage were worst independent predicators of overall survival as well as perineural invasion for local recurrence and distant metastasis. In our analysis, radiotherapy did not have a relevant impact on survival, except in cases of solid histologic subtype. To analyze distant metastatic capacity, long term follow-up was necessary, since distant metastasis way occurs even after 10 years, which has the case with 4 patients.展开更多
目的:构建预测头颈部腺样囊性癌(ACCHN)患者生存情况的列线图。方法:选择2000年至2017年SEER数据库的2 108例ACCHN患者作为建模队列,通过Cox回归分析筛选影响患者预后的独立因素,构建预测患者3 a、5 a总生存率(OS)和癌症特异性生存率(C...目的:构建预测头颈部腺样囊性癌(ACCHN)患者生存情况的列线图。方法:选择2000年至2017年SEER数据库的2 108例ACCHN患者作为建模队列,通过Cox回归分析筛选影响患者预后的独立因素,构建预测患者3 a、5 a总生存率(OS)和癌症特异性生存率(CSS)的列线图。选取2000年至2017年确诊的149例ACCHN患者作为外部验证队列,采用一致性指数(C指数)、ROC曲线和校准曲线评估列线图的性能。结果:年龄、性别、单原发癌、手术、化疗、原发部位、T分期、N分期、M分期是OS的影响因素。年龄、单原发癌、手术、化疗、原发部位、AJCC分期、T分期、N分期、M分期是CSS的影响因素。以上特征均整合在预测3 a和5 a OS和CSS的列线图中,内部验证C指数(95%CI)分别为0.770(0.754~0.786)和0.602(0.584~0.620),外部验证C指(95%CI)分别为0.796(0.795~0.797)和0.781(0.780~0.782)。内部验证中预测3 a和5 a OS的AUC(95%CI)分别为0.826(0.803~0.849)和0.814(0.792~0.835),预测3 a和5 a CSS的AUC(95%CI)分别为0.845(0.820~0.871)和0.834(0.811~0.857);外部验证中预测3 a和5 a OS的AUC(95%CI)分别为0.855(0.779~0.932)和0.838(0.768~0.909),预测3 a和5 a CSS的AUC(95%CI)分别为0.806(0.701~0.911)和0.806(0.726~0.886)。结论:本研究所构建的列线图可以准确预测ACCHN患者的OS和CSS,有助于个性化的预后评估和临床决策。展开更多
文摘Objectives: The biologic behavior of the adenoid cystic carcinoma (ACC) and the factors predicting outcome for these tumors are still poorly understood. Our objective is to analyze the predicting factors and the value of different treatment possibilities, since none sole treatment has been standardized. Methods: A retrospective analysis of the epidemiologic, clinical and histologic aspects of ACC, as well as treatment options and other prognostic factors of all the cases of ACC of the head and neck treated at this Institution were analyzed. From 1974 until 2011, 152 patients were diagnosed with ACC and treated at the Portuguese Institute of Oncology (Porto Centre). Main outcome measures: overall survival, local recurrence and distant metastasis were calculated by the Kaplan-Meier method. Factors predictive of outcome were identified by univariate and multivariate analysis. Results: The mean age at diagnosis was 55.8 years (range, 19-83 years). Incidence was higher in the female population, with a female to male ratio of 1.7:1 respectively. The primary tumor location was hard palate and submandibular region in 56 cases, 28 in each location (24.6%), parotid gland (17 cases, 14.9%) and oral cavity excluding palate (16 cases, 14%).Distributions according to T stage were: T1 (29.8%);T2 (30.7%);T3 (17.5%);T4 (22%). The overall 1-year, 5-year and 10-year survival for all patients were 94.6%, 60.5%, 41.6%, respectively. Conclusions: Univariate survival analysis revealed that age older than 60 years (p = 0.002), solid histologic subtype (p = 0.042), advanced clinical stage (p p = 0.036) were correlated with a poor survival. Multivariate analysis confirmed that age and advanced clinical stage were worst independent predicators of overall survival as well as perineural invasion for local recurrence and distant metastasis. In our analysis, radiotherapy did not have a relevant impact on survival, except in cases of solid histologic subtype. To analyze distant metastatic capacity, long term follow-up was necessary, since distant metastasis way occurs even after 10 years, which has the case with 4 patients.
文摘目的:构建预测头颈部腺样囊性癌(ACCHN)患者生存情况的列线图。方法:选择2000年至2017年SEER数据库的2 108例ACCHN患者作为建模队列,通过Cox回归分析筛选影响患者预后的独立因素,构建预测患者3 a、5 a总生存率(OS)和癌症特异性生存率(CSS)的列线图。选取2000年至2017年确诊的149例ACCHN患者作为外部验证队列,采用一致性指数(C指数)、ROC曲线和校准曲线评估列线图的性能。结果:年龄、性别、单原发癌、手术、化疗、原发部位、T分期、N分期、M分期是OS的影响因素。年龄、单原发癌、手术、化疗、原发部位、AJCC分期、T分期、N分期、M分期是CSS的影响因素。以上特征均整合在预测3 a和5 a OS和CSS的列线图中,内部验证C指数(95%CI)分别为0.770(0.754~0.786)和0.602(0.584~0.620),外部验证C指(95%CI)分别为0.796(0.795~0.797)和0.781(0.780~0.782)。内部验证中预测3 a和5 a OS的AUC(95%CI)分别为0.826(0.803~0.849)和0.814(0.792~0.835),预测3 a和5 a CSS的AUC(95%CI)分别为0.845(0.820~0.871)和0.834(0.811~0.857);外部验证中预测3 a和5 a OS的AUC(95%CI)分别为0.855(0.779~0.932)和0.838(0.768~0.909),预测3 a和5 a CSS的AUC(95%CI)分别为0.806(0.701~0.911)和0.806(0.726~0.886)。结论:本研究所构建的列线图可以准确预测ACCHN患者的OS和CSS,有助于个性化的预后评估和临床决策。
