Survival outcomes, prognostic factors, and effect of adjuvant radiotherapy and prophylactic neck dissection in salivary acinic cell carcinoma: A prospective multicenter REFCOR study of 187 patients

Florian Chatelet (1) , François Régis Ferrand , Sarah Atallah (2) , Juliette Thariat (3) , François Mouawad (4) , Nicolas Fakhry (5, 6) , Olivier Malard , Caroline Even , Erwan de Monès , Emmanuelle Uro-Coste (7) , Nazim Benzerdjeb (8) , Stéphane Hans (9) , Sylvie Testelin (10, 11, 12) , Olivier Mauvais (13) , Diane Evrard , Vianney Bastit , Sébastien Salas (14) , Florent Espitalier , Marion Classe , Laurence Digue (15) , Mélanie Doré , Stéphanie Wong , Charles Dupin , France Nguyen , Jeremie Bettoni (11, 12) , Ariane Lapierre , Emilien Colin , Pierre Philouze , Sébastien Vergez , Bertrand Baujat , Philippe Herman , Benjamin Verillaud , Jean-Marc Constans (16, 11, 12) , Alexandre Coutte (16, 11, 12) , Bernard Devauchelle (11, 10, 12)

1 Service d'ORL et de Chirurgie cervico-faciale - Hôpital Foch
2 CHU Tenon [AP-HP]
3 LPCC - Laboratoire de physique corpusculaire de Caen
4 Faculté de Médecine Henri Warembourg - Université de Lille
5 LPL - Laboratoire Parole et Langage
6 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
7 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
8 HCL - Hospices Civils de Lyon
9 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
10 CMF et Stomatologie - Chirurgie maxillofaciale et Stomatologie [CHU Amiens]
11 CHIMERE - CHirurgie, IMagerie et REgénération tissulaire de l’extrémité céphalique - Caractérisation morphologique et fonctionnelle - UR UPJV 7516
12 REFCOR - Réseau d’Expertise Français sur les Cancers ORL Rares - French Network of Rare Head and Neck Tumors
13 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
14 COMPO - Méthodes computationnelles pour la prise en charge thérapeutique en oncologie : Optimisation des stratégies par modélisation mécaniste et statistique
15 Hôpital Pellegrin
16 CHU Amiens-Picardie

Background: Acinic cell carcinomas (AciCCs) are malignant tumours of the salivary glands. The aim of this work was to analyse data from the national REFCOR multicenter cohort (i) to investigate the prognostic factors influencing survival outcomes in AciCC, (ii) to assess the impact on survival of postoperative radiotherapy (RT) in patients treated for AciCC without high-grade transformation and (iii) to explore the prognostic impact of prophylactic neck dissection (ND) in patients treated for AciCC of the major salivary glands. Patients and methods: Data from all the patients treated for salivary AciCC between 2009 and 2020 were extracted from the REFCOR database. Survival outcomes and prognostic factors influencing Disease-Free Survival (DFS) and Overall Survival (OS) were investigated using univariate and multivariate analyses. Propensity score matching was used to assess the impact of postoperative RT and prophylactic ND on DFS. Results: A total of 187 patients were included. After a median follow-up of 53 months, their 5-year OS and DFS rates were 92.8% and 76.2%, respectively. In multivariate analysis, male sex, older age, higher T and N status, and high grade were independently associated with a worse DFS. In the subpopulation analysed after propensity score matching, patients with cN0 AciCC without high-grade transformation who were treated by surgery and RT did not have an improved DFS compared to patients who were treated by surgery alone (hazard ratio (HR) = 0.87, p = 0.8). Factors associated with nodal invasion were T3-T4 status and intermediate/high histological grade. After propensity score matching, prophylactic ND was associated with a trend toward a better DFS (HR = 0.46, p = 0.16). Conclusions: These results suggest that (i) long-term follow-up (>5 years) should be considered in patients with AciCC, (ii) treatment by surgery alone could be an option in selected cN0 patients with AciCC without high-grade transformation and (iii) prophylactic ND may be considered preferentially in patients with T3-T4 status and/or intermediate/high histological grade.

Mots clés: Neck dissection; Prognosis; Propensity score; Radiotherapy; Salivary gland neoplasms; Acinar cell; Acinic cell carcinoma; Carcinoma

Domaines: Médecine humaine et pathologie

Florian Chatelet, François Régis Ferrand, Sarah Atallah, Juliette Thariat, François Mouawad, et al.. Survival outcomes, prognostic factors, and effect of adjuvant radiotherapy and prophylactic neck dissection in salivary acinic cell carcinoma: A prospective multicenter REFCOR study of 187 patients. European Journal of Cancer, 2023, 185, pp.11-27. ⟨10.1016/j.ejca.2023.02.020⟩. ⟨hal-04044097⟩