0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.242.8.162. Please contact the publisher to request reinstatement.
Original Investigation |

Prognostic Factors Associated With Decreased Survival in Patients With Acinic Cell Carcinoma

David M. Neskey, MD1; Jonah D. Klein, BS2; Stephanie Hicks, PhD3; Adam S. Garden, MD4; Diana M. Bell, MD5; Adel K. El-Naggar, MD5; Merrill S. Kies, MD6; Randal S. Weber, MD1; Michael E. Kupferman, MD1
[+] Author Affiliations
1Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
2School of Medicine, Temple University Medical School, Philadelphia, Pennsylvania
3Department of Statistics, Rice University, Houston, Texas
4Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
5Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
6Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1195-1202. doi:10.1001/jamaoto.2013.4728.
Text Size: A A A
Published online

Importance  Acinic cell carcinoma is a rare salivary neoplasm that is generally associated with a good prognosis, although a subset of patients develops local and distant recurrences. Given the rarity of the disease, factors to identify patients at risk for recurrences or decreased survival are not clearly defined.

Objectives  To identify clinicopathologic factors associated with adverse survival in patients with acinic cell carcinoma and to assess the effect of local, regional, and distant recurrences on survival.

Design, Setting, and Participants  Retrospective medical record review in a tertiary care cancer center of 155 patients treated for acinic cell carcinoma from January 1990 through Febraury 2013.

Main Outcomes and Measures  Primary outcomes evaluated were overall and disease-free survival. The end points assessed were age at diagnosis, sex, size of primary tumor, presence of positive surgical margins, postoperative radiation therapy, and development of local, regional, or distant recurrences.

Results  The median survival was 28.5 years, with 13 patients (8.4%) dying of their disease. Women (n = 104) were affected twice as often as men (n = 51) but had an improved survival (P < .001). Patients diagnosed as having acinic cell carcinoma before or at the age of 45 years had an improved survival (P = .02) compared with their elder counterparts, a finding that was independent of sex. Neoplasms larger than 3 cm at presentation were associated with a decreased overall survival compared with smaller lesions (P = .02). The development of distant metastases was most associated with death from the disease (odds ratio, 49.90; 95% CI, 6.49-2246.30; P <.001) compared with local and regional recurrences.

Conclusions and Relevance  Although patients with acinic cell carcinoma generally have a favorable prognosis, we have identified several factors associated with decreased survival, including male sex, age older than 45 years, neoplasms larger than 3 cm, and the development of a distant recurrence. These results suggest that maximizing local and regional control for this disease can offer substantial benefit when no distant disease is detectable.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Effect of Age on Survival

Patients older than 45 years (n = 96) have a decreased overall (A) and disease-free survival (B) with an increased rate of distant metastases (DM) (C) compared with patients 45 years and younger (n = 59). Log rank tests confirmed that the overall and disease-free survival curves were significantly different (P = .02 and .03, respectively). The curve for time to distant metastases was not statistically significant (P = .14).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Effect of Early vs Late T Stage and Tumor Size on Overall Survival

A, Patients who presented with early-stage disease (stages I and II) (n = 69) had a significantly improved survival compared with patients with late-stage disease (P = .02) (n = 19). B, Patients with tumors larger than 3 cm also had a significantly decreased overall survival compared with smaller tumors (P = .04) (n = 31 and 49, respectively).

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
Jobs
brightcove.createExperiences();