American Joint Committee on Cancer Classification Predicts Outcome of Patients with Lacrimal Gland Adenoid Cystic Carcinoma

• Published in: Ophthalmology (Rochester, Minn.) Vol. 116; no. 6; pp. 1210 - 1215
• Main Authors: Ahmad, S. Mehdi, MD, Esmaeli, Bita, MD, Williams, Michelle, MD, Nguyen, John, MD, Fay, Aaron, MD, Woog, John, MD, Selvadurai, Deepan, MD, Rootman, Jack, MD, Weis, Ezekiel, MD, Selva, Dinesh, MD, McNab, Alan, FRANZCO, DeAngelis, Dan, MD, Calle, Alberto, MD, Lopez, Adriana, MS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2009; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Carcinoma, Adenoid Cystic - classification; Carcinoma, Adenoid Cystic - mortality; Carcinoma, Adenoid Cystic - pathology; Carcinoma, Adenoid Cystic - therapy; Child; Combined Modality Therapy; Eye Neoplasms - classification; Eye Neoplasms - mortality; Eye Neoplasms - pathology; Eye Neoplasms - therapy; Female; Humans; Lacrimal Apparatus Diseases - classification; Lacrimal Apparatus Diseases - mortality; Lacrimal Apparatus Diseases - pathology; Lacrimal Apparatus Diseases - therapy; Male; Medical sciences; Middle Aged; Miscellaneous; Neoplasm Invasiveness; Neoplasm Recurrence, Local - diagnosis; Neoplasm Staging; Ophthalmologic Surgical Procedures; Ophthalmology; Radiotherapy; Retrospective Studies; Societies, Medical; Survival Rate; Treatment Outcome; United States; United States; Human; Carcinoma; Lacrimal gland; Prognosis; Classification; Prediction; Evolution; Ophthalmology; Malignant tumor; Joint; Cancer
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2008.12.049

Purpose To investigate whether American Joint Committee on Cancer (AJCC) classification at initial diagnosis of lacrimal gland adenoid cystic carcinoma predicts outcome of treatment on local recurrence. Design Retrospective chart review. Participants Consecutive patients with adenoid cystic carcinoma of the lacrimal gland treated at 8 institutions between January 1986 and December 2007. Methods Clinical records, including pathology reports and imaging studies, were reviewed. Main Outcome Measures AJCC classification, histologic subtype, local recurrence rate, and survival. Results AJCC classification at initial diagnosis was assessable for 53 patients and was as follows: T1N0M0, 7 patients; T2N0M0, 8 patients; T3aN0M0, 14 patients; T3aNxM0, 1 patient; T3aN0M1, 1 patient; T3bN0M0, 13 patients; T3bN0M1, 1 patient; T4aN0M0, 2 patients; T4bN0M0, 4 patients; T4bN0M1, 1 patient; and T4bNXM0, 1 patient. Thirty-eight (72%) of the 53 patients had >T3 tumors at presentation. Of the 38 patients with >T3 tumors, 20 were treated with orbital exenteration and postoperative adjuvant radiotherapy (RT), 6 were treated with orbital exenteration without RT, and 12 were treated with globe-preserving surgery (10 with RT and 2 without RT). Of the 15 patients with <T3 tumors, 6 were treated with globe-preserving surgery and RT, 2 were treated with globe-preserving surgery without RT, 6 were treated with orbital exenteration with bone removal and RT, and 1 was treated with orbital exenteration with bone removal without RT. Only 1 patient with a <T3 tumor, had local recurrence. Among patients with >T3 tumors, the risk of local recurrence (in the orbit or skull base) was higher in patients treated with conservative surgery as opposed to orbital exenteration and RT. Only 4 (20%) of the 20 patients treated with orbital exenteration and RT had local recurrence, compared with 3 (50%) of the 6 patients treated with orbital exenteration without RT and 8 (67%) of the 12 patients treated with globe-preserving surgery. Overall, 17 (45%) of the 38 patients with >T3 tumors and only 1 (7%) of the 15 patients with <T3 tumors died of disease during the study period. Conclusions In patients with lacrimal gland adenoid cystic carcinoma, AJCC >T3 disease at initial diagnosis correlates with worse outcomes than does AJCC <T3 disease. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.