Patterns of recurrence and survival of head and neck adenoid cystic carcinoma after definitive resection.

OBJECTIVES/HYPOTHESIS To determine factors impacting recurrence and long-term survival of adenoid cystic carcinoma (ACC) of the head and neck after definitive resection. STUDY DESIGN Retrospective cohort study at an academic tertiary care hospital. METHODS Patients with ACC of the head and neck treated at our institution were reviewed. Those not receiving surgery, or with metastatic disease were excluded. Clinicopathological data on each patient was collected. RESULTS Of 113 patients identified with ACC, 99 were studied. The overall median survival for the cohort was 71 months (mean +/- standard deviation, 94 +/- 79 months). American Joint Committee on Cancer (AJCC) tumor stage and N stage were independent predictors of survival on multivariate analysis. Mean overall survival (P = .001) and time to recurrence (P = .006) were lower for patients with cervical lymph node positive disease (N+). Tumors in major salivary glands were associated with longer survival (P = .027). The overall recurrence rate was 53%, with a mean time to recurrence of 63 +/- 64 months. The presence of lymphovascular invasion predicted recurrence on multivariate analysis (P = .002), with advanced tumor stage predicting early (<or=36 months) recurrence (P = .013). Among the 57 patients who received adjuvant radiation therapy, there was no difference in survival, rate of recurrence, or time to recurrence, when compared to patients treated with surgery alone. CONCLUSIONS Clinicopathological variables including AJCC tumor stage, tumor site, presence of N+ disease, and lymphovascular invasion may be used as prognostic factors in predicting survival and recurrence after a definitive resection of ACC of the head and neck.