Survival outcomes, prognostic factors, and effect of adjuvant radiotherapy and prophylactic neck dissection in salivary acinic cell carcinoma: A prospective multicenter REFCOR study of 187 patients

Florian Chatelet; François Régis Ferrand; Sarah Atallah; Juliette Thariat; François Mouawad; Nicolas Fakhry; Olivier Malard; Caroline Even; Erwan de Monès; Emmanuelle Uro-Coste; Nazim Benzerdjeb; Stéphane Hans; Sylvie Testelin; Olivier Mauvais; Diane Evrard; Vianney Bastit; Sébastien Salas; Florent Espitalier; Marion Classe; Laurence Digue; Mélanie Doré; Stéphanie Wong; Charles Dupin; France Nguyen; Jeremie Bettoni; Ariane Lapierre; Emilien Colin; Pierre Philouze; Sébastien Vergez; Bertrand Baujat; Philippe Herman; Benjamin Verillaud; REFCOR members

doi:10.1016/j.ejca.2023.02.020

Survival outcomes, prognostic factors, and effect of adjuvant radiotherapy and prophylactic neck dissection in salivary acinic cell carcinoma: A prospective multicenter REFCOR study of 187 patients

Eur J Cancer. 2023 May:185:11-27. doi: 10.1016/j.ejca.2023.02.020. Epub 2023 Mar 2.

Authors

Florian Chatelet¹, François Régis Ferrand², Sarah Atallah³, Juliette Thariat⁴, François Mouawad⁵, Nicolas Fakhry⁶, Olivier Malard⁷, Caroline Even⁸, Erwan de Monès⁹, Emmanuelle Uro-Coste¹⁰, Nazim Benzerdjeb¹¹, Stéphane Hans¹², Sylvie Testelin¹³, Olivier Mauvais¹⁴, Diane Evrard¹⁵, Vianney Bastit¹⁶, Sébastien Salas¹⁷, Florent Espitalier¹⁸, Marion Classe¹⁹, Laurence Digue⁹, Mélanie Doré²⁰, Stéphanie Wong²¹, Charles Dupin²², France Nguyen²³, Jeremie Bettoni¹³, Ariane Lapierre²⁴, Emilien Colin¹³, Pierre Philouze²⁵, Sébastien Vergez²⁶, Bertrand Baujat²⁷, Philippe Herman²⁸, Benjamin Verillaud²⁸; REFCOR members

Affiliations

¹ Department of ENT-Head and Neck Surgery, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, F-75010 Paris, France. Electronic address: florian.chatelet@aphp.fr.
² French Armed Forces Biomedical Research Institute, F-91220 Brétigny sur Orge, France; Head and Neck Oncology Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, F-94807 Villejuif, France.
³ Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la chine, F-75020 Paris, France; Doctoral School of Public Health, CESP, University of Paris Sud, 16 Avenue Paul Vaillant Couturier, F-94807 Villejuif, France.
⁴ Department of Radiation Oncology, Centre Francois Baclesse, F-14000 Caen, France; ARCHADE Research Community, F-14000 Caen, France; Laboratoire de physique Corpusculaire IN2P3/ENSICAEN/CNRS UMR 6534-Normandie Université, F-14000 Caen, France.
⁵ Department of ENT-Head and Neck Surgery, Université de Lille, Hôpital Huriez, CHU de Lille, Rue Michel Polonovski, 59000 Lille, France; Inserm U 908, Université des Sciences et Technologies de Lille, UFR de Biologie - SN3, 59655 Villeneuve d'Ascq, France.
⁶ Department of ENT-Head and Neck Surgery, CHU La Conception, AP-HM. Aix-Marseille Univ (AMU), Marseille, France.
⁷ Service d'ORL et de chirurgie cervico-faciale CHU 1, INSERM U1229-RMeS, Place A. Ricordeau Hôtel-Dieu, F-44093 Nantes Cedex, France.
⁸ Head and Neck Oncology Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, F-94807 Villejuif, France.
⁹ Uni. Bordeaux, CHU Bordeaux, F-33000 Bordeaux, France.
¹⁰ Department of Pathological Anatomy and Histology-Cytology, Rangueil Hospital, Toulouse, France.
¹¹ Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University, Lyon 1, France.
¹² Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
¹³ EA 7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France; Department of Maxillofacial Surgery, Amiens-Picardy University Hospital, Université de Picardie Jules Verne, Amiens, France.
¹⁴ Department of ENT-Head and Neck Surgery, Centre Hospitalier Universitaire de Besançon, Besançon, France.
¹⁵ Université de Paris, Department of ENT-Head and Neck Surgery, Hôpital Bichat, AP-HP, 46 Rue Henri Huchard, F-75018 Paris, France.
¹⁶ Department of ENT-Head and Neck Surgery, François Baclesse Centre, 3 rue du Général Harris, 14000, Caen, France.
¹⁷ Medical Oncology Department, Centre Hospitalier (CHU) La Timone, F-13000, Marseille, France.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, CHU de Nantes, F-44093 Nantes, France.
¹⁹ Pathology Department, Gustave Roussy Cancer Campus, France.
²⁰ Institut de cancérologie de l'Ouest Nantes, 2 boulevard Jacques Monod, F-44805 Saint Herblain, France.
²¹ Radiation Oncology Department, Hôpital Timone Adultes, 264 Rue Saint-Pierre, F-13005 Marseille, France.
²² Department of Radiation Therapy, Hôpital de Haut Lévèque, Bordeaux University Hospital-CHU, F-33000 Bordeaux, France.
²³ Onco-radiotherapy Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, F-94807 Villejuif, France.
²⁴ Claude Bernard University, Lyon 1, France; Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chem. du Grand Revoyet, F-69310 Pierre-Bénite, France.
²⁵ Claude Bernard University, Lyon 1, France; Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
²⁶ Department of Surgery, University Cancer Institute Toulouse - Oncopôle, University Hospital of Toulouse, F-31100 Toulouse, France.
²⁷ Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la chine, F-75020 Paris, France.
²⁸ Department of ENT-Head and Neck Surgery, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, F-75010 Paris, France; Université de Paris, INSERM U1141, Unité"NeuroDiderot", Université de Paris, F-75006 Paris, France.

PMID: 36947928
DOI: 10.1016/j.ejca.2023.02.020

Abstract

Background: Acinic cell carcinomas (AciCCs) are malignant tumours of the salivary glands. The aim of this work was to analyse data from the national REFCOR multicenter cohort (i) to investigate the prognostic factors influencing survival outcomes in AciCC, (ii) to assess the impact on survival of postoperative radiotherapy (RT) in patients treated for AciCC without high-grade transformation and (iii) to explore the prognostic impact of prophylactic neck dissection (ND) in patients treated for AciCC of the major salivary glands.

Patients and methods: Data from all the patients treated for salivary AciCC between 2009 and 2020 were extracted from the REFCOR database. Survival outcomes and prognostic factors influencing Disease-Free Survival (DFS) and Overall Survival (OS) were investigated using univariate and multivariate analyses. Propensity score matching was used to assess the impact of postoperative RT and prophylactic ND on DFS.

Results: A total of 187 patients were included. After a median follow-up of 53 months, their 5-year OS and DFS rates were 92.8% and 76.2%, respectively. In multivariate analysis, male sex, older age, higher T and N status, and high grade were independently associated with a worse DFS. In the subpopulation analysed after propensity score matching, patients with cN0 AciCC without high-grade transformation who were treated by surgery and RT did not have an improved DFS compared to patients who were treated by surgery alone (hazard ratio (HR) = 0.87, p = 0.8). Factors associated with nodal invasion were T3-T4 status and intermediate/high histological grade. After propensity score matching, prophylactic ND was associated with a trend toward a better DFS (HR = 0.46, p = 0.16).

Conclusions: These results suggest that (i) long-term follow-up (>5 years) should be considered in patients with AciCC, (ii) treatment by surgery alone could be an option in selected cN0 patients with AciCC without high-grade transformation and (iii) prophylactic ND may be considered preferentially in patients with T3-T4 status and/or intermediate/high histological grade.

Keywords: Acinar cell; Acinic cell carcinoma; Carcinoma; Neck dissection; Prognosis; Propensity score; Radiotherapy; Salivary gland neoplasms.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Acinar Cell* / pathology
Carcinoma, Acinar Cell* / radiotherapy
Carcinoma, Acinar Cell* / surgery
Humans
Male
Neck Dissection
Prognosis
Prospective Studies
Radiotherapy, Adjuvant
Retrospective Studies
Salivary Gland Neoplasms* / radiotherapy
Salivary Gland Neoplasms* / surgery