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Eur J Cancer. 2020 Jan 30. pii: S0959-8049(19)30894-9. doi: 10.1016/j.ejca.2019.12.026. [Epub ahead of print]

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

Author information

1
Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la chine, 75020, Paris, France; Doctoral School of Public Health, CESP, University of Paris Sud, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif, France.
2
Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard Vaillant, 94805, Villejuif, France.
3
Department of ENT-Head and Neck Surgery, Nantes University Hospital, 1 Place Alexis-Ricordeau, 44000, Nantes, France.
4
Department of ENT-Head and Neck Surgery, Centre Antoine-Lacassagne-IUFC, 31 Avenue de Valombrose, 06189, Nice, France.
5
Department of ENT-Head and Neck Surgery, University Hospital of Marseille, APHM, 13915, Marseille, France.
6
Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, Avenue René Laennec, 80000, Amiens, France.
7
Department of ENT-Head and Neck Surgery, Regional University Hospital of Nancy, Hospital of Brabois, 54035, Nancy, France.
8
Department of ENT-Head and Neck Surgery, University Hospital of Liège, Belgium.
9
Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse, Toulouse University Hospital, 1 avenue Irène Joliot-Curie, 31400, Toulouse, France.
10
Department of ENT-Head and Neck Surgery, University Hospital of Bordeaux, Hôpital Pellegrin, Centre Michelet, Place Amélie Raba-Léon, 33076, Bordeaux, France.
11
Department of ENT-Head and Neck Surgery, Hospital Bichat, APHP, 75018, Paris, France.
12
Department of ENT-Head and Neck Surgery, Curie Institute, 26 rue d'Ulm, 75005, Paris, France.
13
Department of ENT-Head and Neck Surgery, Hospices Civils de Lyon, Lyon-Nord University Hospital, 103 Grande Rue de la Croix Rousse, 69000, Lyon, France.
14
Department of Oral and Maxillofacial Surgery, Sorbonne University, Pitié-Salpétrière Hospital, APHP, 75013, Paris, France.
15
Department of ENT-Head and Neck Surgery, University Hospital of Strasbourg, 67000, Strasbourg, France.
16
Department of ENT-Head and Neck Surgery, Tours Bretonneau University Hospital, 2 Boulevard Tonnellé, 37000, Tours, France.
17
Department of ENT-Head and Neck Surgery, François Baclesse Centre, 3 rue du Général Harris, 14000, Caen, France.
18
Department of ENT-Head and Neck Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble, France.
19
Department of ENT-Head and Neck Surgery, Georges Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015, Paris, France.
20
Department of ENT-Head and Neck Surgery, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France.
21
Department of ENT-Head and Neck Surgery, University Hospital of Besançon, France, 25000, Besançon, France.
22
Department of Radiotherapy, Jean Perrin Centre, University Clermont Auvergne, 63100, Clermont-Ferrand, France.
23
Department of ENT-Head and Neck and Maxillofacial Surgery, University Hospital of Poitiers, 2 Rue de la Milétrie, CS 90577, 86021, Poitiers, France.
24
Department of ENT-Head and Neck Surgery, Rouen University Hospital, 1 rue de Germont, 76031, Rouen, France.
25
Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, Reims, France.
26
Department of ENT-Head and Neck Surgery, Lariboisière University Hospital,INSERM U1141, Paris Diderot University, APHP, 75010, Paris, France.
27
Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la chine, 75020, Paris, France. Electronic address: bertrand.baujat@aphp.fr.

Abstract

BACKGROUND:

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.

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.

KEYWORDS:

Adenoid cystic carcinoma; Neck dissection; REFCOR; Salivary gland cancer; Surgery

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

Conflict of interest statement

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

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