ENT Medical News about parotid gland;acinic cell carcinoma;prognostic features

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Clinical and pathologic prognostic features in acinic cell carcinoma of the parotid gland
Cancer, 03/31/09

Gomez DR et al. - In a trial to determine patterns of failure and adverse prognostic features for adjuvant treatment in acinic cell carcinoma (AciCC) of the parotid gland, it was shown that AciCC had a low treatment failure rate, and a large number of pts could be considered candidates for surgery only. A histologic grading system was devised to help stratify pts for adjuvant treatment.

Methods

35 pts underwent surgery for AciCC of the parotid gland and had their clinical and pathologic features retrospectively analyzed at the primary site.
All cases were reviewed by 2 head and neck pathologists.
5-yr estimates of survival outcomes were performed, followed by univariate analysis of potential prognostic features.

Results

T classifications were as follows: T1 in 46% of pts, T2 in 23%, T3 in 18%, and T4 in 9%.
3 pts had cervical lymph node involvement.
All pts underwent surgery as their primary treatment; approximately 63% received radiation treatment.
Median follow-up time for surviving pts was 59.9 mos; 5-yr estimates of disease-free survival (DFS), overall survival (OS), and local control were 85%, 90%, and 90%, respectively.
Of the clinical variables tested, clinical extracapsular extension (ECE), facial nerve sacrifice, and lymph node involvement were significantly associated with a detriment in DFS and OS.
Positive surgical margins, histologic ECE, >2 mitoses per 10 high-power fields (HPF), atypical mitosis, vascular invasion, perineural invasion, pleomorphism, and necrosis were associated with adverse DFS.
All variables except for vascular invasion and perineural invasion were associated with OS.
If high-grade tumors were defined on the basis of high mitotic activity (>2 mitoses/10 HPF) and/or tumor necrosis, high-grade carcinomas had a significantly lower DFS and OS.

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