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

Ting-yao Ma, Jun Wu, Shi-zhi He, Xue-lian Wang, Guo-liang Yang, Shu-jing Zhang, Jin Zhou, Yi-ming Ding, Li-feng Li, Hong-fei Liu, Lan-lan Xuan, Xiao-hong Chen
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Abstract

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.

Abstract Image

头颈部腺样囊性癌高级别转化显示出独特的临床病理特征和不良预后:中国最大系列的匹配病例对照研究
目的 在腺样囊性癌(ACC)罕见的高级别转化(HGT)中,本研究对其侵袭性和临床影响提供了前所未有的见解。方法 从412例ACC病例中提取23例HGT患者与非HGT患者进行1:1匹配比较,重点剖析独特的临床病理特征和预后结果。值得注意的是,实性亚型是 HGT 中最常见的类型,占 69.6%。与非HGT相比,HGT队列的淋巴结转移率(39.1% vs. 8.7%; P <0.05)、神经周围浸润率(60.9% vs. 26.1%; P <0.05)和Ki-67增殖指数(35.0% vs. 10.0%; P <0.05)明显更高。此外,HGT区域通常显示出p63表达减少或缺失,以及高级别病理形态。HGT与复发(55.0%)和远处转移(78.3%)增加有关,导致平均生存期为35.9个月,3年死亡率为35.0%。结论这项研究是我们所知的规模最大的单中心 HGT 病例群,强调了其在鼻窦和泪腺的频繁发生以及与较差预后的关联。研究结果支持将 ACC 中的 HGT 分为 4 级,以反映其严重程度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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