High-grade transformation of head and neck adenoid cystic carcinoma demonstrates distinctive clinicopathological features and an unfavorable prognosis: a matched case-control study of the largest series in China.

Publisher: Country of Publication: Italy NLM ID: 101247119 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1699-3055 (Electronic) Linking ISSN: 1699048X NLM ISO Abbreviation: Clin Transl Oncol Subsets: MEDLINE

Publication: <2010- >: Milan : Springer Italia
Original Publication: Barcelona, Spain : Doyma, c2005-

Carcinoma, Adenoid Cystic*/pathology ; Carcinoma, Adenoid Cystic*/mortality; Humans ; Male ; Female ; Middle Aged ; Prognosis ; China/epidemiology ; Case-Control Studies ; Adult ; Aged ; Head and Neck Neoplasms/pathology ; Head and Neck Neoplasms/mortality ; Neoplasm Grading ; Cell Transformation, Neoplastic/pathology ; Lymphatic Metastasis ; Survival Rate ; Neoplasm Invasiveness ; Young Adult

Purpose: Amidst the rarity of High-grade transformation (HGT) in adenoid cystic carcinoma (ACC), this study offers unprecedented insights into its aggressive nature and clinical implications.
Methods: A 1:1 match comparison between 23 HGT patients and non-HGT counterparts was extracted from 412 ACC cases, focusing on dissecting distinctive clinicopathological features and prognostic outcomes.
Results: The predominant sites of HGT were the sinonasal and lacrimal glands (30.4% each). Notably, the solid subtype was the most prevalent pattern within HGT, accounting for 69.6% of cases. Compared to non-HGT, the HGT cohort exhibited significantly higher rates of lymph node metastasis (39.1% vs. 8.7%; P < 0.05), perineural invasion (60.9% vs. 26.1%; P < 0.05), and increased Ki-67 proliferation index (35.0% vs. 10.0%; P < 0.05). Moreover, HGT regions typically showed reduced or absent p63 expression, along with high-grade pathomorphology. HGT was associated with increased recurrence (55.0%) and distant metastasis (78.3%), leading to an average survival of 35.9 months and a 3-years mortality rate of 35.0%. Overall and progression-free survival rates were significantly decreased in the HGT group.
Conclusion: This study represents the largest single-center cohort of HGT cases to our knowledge, highlighting its frequent occurrence in the sinonasal and lacrimal glands and association with poorer outcomes. The findings support classifying HGT in ACC as Grade 4, reflecting its severity.
(© 2023. The Author(s), under exclusive licence to Federación de Sociedades Españolas de Oncología (FESEO).)

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grant no. 82173312 National Natural Science Foundation of China; grant no. 2022-2-2057 Capital's Funds for Health Improvement and Research

Keywords: Adenoid cystic carcinoma; Case–control study; Dedifferentiation; Head and neck cancer; High-grade transformation

Date Created: 20231214 Date Completed: 20240521 Latest Revision: 20240521

20240521

10.1007/s12094-023-03357-5

38097822