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The role of elective neck dissection in patients with adenoid cystic carcinoma of the head and neck
Author(s) -
Xiao Roy,
Sethi Rosh K.V.,
Feng Allen L.,
Fontanarosa Joel B.,
Deschler Daniel G.
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27814
Subject(s) - medicine , neck dissection , adenoid cystic carcinoma , soft palate , proportional hazards model , head and neck cancer , tongue , larynx , occult , surgery , hazard ratio , carcinoma , cancer , pathology , confidence interval , alternative medicine
Objective To investigate the frequency and outcomes of elective neck dissection (END) for adenoid cystic carcinoma (ACC) of the head and neck. Methods The National Cancer Database was queried for a cohort study of patients with ACC of the major salivary glands, nasal cavity/nasopharynx, hard/soft palate, tongue, floor of mouth, larynx, and oral cavity who underwent primary surgical resection from 2004 to 2014. Multivariable logistic regression was used to identify predictors of END and occult nodal metastasis. Overall survival (OS) was estimated using the Kaplan‐Meier method and modeled with Cox proportional hazards regression. Results Among 2,807 patients with ACC treated surgically, 636 (22.7%) underwent END. Patients with ACC of the salivary glands and tongue most frequently underwent END; patients with hard/soft palate (odds ratio [OR] 0.06, P < 0.001) and nasal cavity/nasopharynx (OR 0.05, P < 0.001) ACC rarely underwent END compared to patients with major salivary gland cancer. Increasing tumor (T) stage (T4 vs. T1, OR 3.02, P < 0.001) was associated with END. Patients with advanced T3 to T4 ACC of the major salivary glands demonstrated extended OS associated with END (5‐year OS 78.1% vs. 70.4%, P = 0.041) on Kaplan‐Meier analysis and with END with adjuvant radiation therapy (hazard ratio 0.55, P = 0.027) using Cox proportional hazards regression. Elective neck dissection for T4 ACC of the salivary glands (21.3%) and tongue (25.5%) most consistently revealed occult nodal metastasis. Conclusion Elective neck dissection for ACC of the major salivary glands or tongue is most likely to reveal occult nodal metastasis. Elective neck dissection is associated with extended OS for advanced‐stage ACC of the major salivary glands. Level of Evidence NA Laryngoscope , 129:2094–2104, 2019