Should a neck dissection be performed on patients with cN0 adenoid cystic carcinoma? A REFCOR propensity score matching study.

Adolescent Adult Aged Aged, 80 and over Carcinoma, Adenoid Cystic / diagnosis Female France / epidemiology Head and Neck Neoplasms / diagnosis Humans Lymph Nodes / pathology Lymphatic Metastasis / diagnosis Male Matched-Pair Analysis Middle Aged Neck Dissection / methods Neoplasm Staging Prognosis Propensity Score Prophylactic Surgical Procedures Prospective Studies Salivary Gland Neoplasms / diagnosis Survival Analysis Treatment Outcome Young Adult

Adenoid cystic carcinoma Neck dissection REFCOR Salivary gland cancer Surgery

Journal

European journal of cancer (Oxford, England : 1990)

ISSN: 1879-0852

Titre abrégé: Eur J Cancer

Pays: England

ID NLM: 9005373

Informations de publication

Date de publication:
05 2020

Historique:

received: 29 09 2019

revised: 17 11 2019

accepted: 26 12 2019

pubmed: 6 2 2020

medline: 10 4 2021

entrez: 4 2 2020

Statut: ppublish

Résumé

Patterns of nodal involvement in adenoid cystic carcinoma (ACC) of the head and neck have not been sufficiently assessed to guide a decision of prophylactic neck dissection (ND). The objective of this study is to analyse the influence of ND on event-free survival (EFS) for patients with cN0 ACC. A multicentre prospective study was conducted between 2009 and 2018. Patients presenting cN0 non-metastatic ACC on any site, and who received surgery on the tumour, were included. EFS was the main judgement criterion. A comparative survival analysis between the groups that received a ND versus those that did not was performed, using a propensity score. Analyses were carried out using the R software. Between 2009 and 2018, 322 patients with cN0 ACC were included, out of which 58% were female. The average age was 53 years. Tumours were in minor salivary glands in 58% of cases, and 52% had T3/T4 stages. ND was performed on 46% of patients. Out of them, seven had histological lymph node invasion, out of which six had tumour infiltration in the mucosa of oral cavity. After propensity score, the median EFS for N0 patients with ND was 72 months (95% Confidence Interval (CI) [48-81]), compared to 73 months (95% CI [52-85]) for patients without ND (HR = 1.33; 95% CI [0.82-2.16]; p = 0.2). ND of cN0 patients does not provide any benefit on EFS, which suggests that its application on such patients is not necessary.

Sections du résumé

BACKGROUND

PATIENTS AND METHODS

A multicentre prospective study was conducted between 2009 and 2018. Patients presenting cN0 non-metastatic ACC on any site, and who received surgery on the tumour, were included. EFS was the main judgement criterion. A comparative survival analysis between the groups that received a ND versus those that did not was performed, using a propensity score. Analyses were carried out using the R software.

RESULTS

Between 2009 and 2018, 322 patients with cN0 ACC were included, out of which 58% were female. The average age was 53 years. Tumours were in minor salivary glands in 58% of cases, and 52% had T3/T4 stages. ND was performed on 46% of patients. Out of them, seven had histological lymph node invasion, out of which six had tumour infiltration in the mucosa of oral cavity. After propensity score, the median EFS for N0 patients with ND was 72 months (95% Confidence Interval (CI) [48-81]), compared to 73 months (95% CI [52-85]) for patients without ND (HR = 1.33; 95% CI [0.82-2.16]; p = 0.2).

CONCLUSION

ND of cN0 patients does not provide any benefit on EFS, which suggests that its application on such patients is not necessary.

Identifiants

DOI: 10.1016/j.ejca.2019.12.026 PMID: 32008920

pubmed: 32008920

pii: S0959-8049(19)30894-9

doi: 10.1016/j.ejca.2019.12.026

pii:

doi:

Types de publication

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

Langues

eng

Sous-ensembles de citation

Pagination

250-258

Informations de copyright

Déclaration de conflit d'intérêts

Conflict of interest statement The authors have declared no conflict of interest.