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. 2024 Nov 30;13(11):6045-6056.
doi: 10.21037/tcr-24-1221. Epub 2024 Nov 27.

Comparison of postoperative radiotherapy and definitive radiotherapy for non-metastatic adenoid cystic carcinoma of the head and neck, a propensity score matching based on the SEER database

Mingyu Tan  1   2 , Yanliang Chen  1   2 , Tianqi Du  1   2 , Qian Wang  1   2 , Xun Wu  1   2 , Xiaohu Wang  2   3 , Hongtao Luo  2   3 , Shilong Sun  2   3 , Qiuning Zhang  2   3 , Wenzhen Yuan  1
Affiliations

Comparison of postoperative radiotherapy and definitive radiotherapy for non-metastatic adenoid cystic carcinoma of the head and neck, a propensity score matching based on the SEER database

Mingyu Tan et al. Transl Cancer Res. .

Abstract

Background: Treating patients with head and neck adenoid cystic carcinoma (HNACC) presents surgical problems in various scenarios. Limited studies explore definitive radiation's impact on patient survival, with inadequate data correlating it to postoperative radiotherapy. Using the Surveillance, Epidemiology, and End Results (SEER) program, we conducted an objective analysis to evaluate the impact of definitive radiation on the survival of HNACC patients without distant metastases, aiming to uncover its nuanced pros and cons.

Methods: This study conducted a comprehensive analysis of individuals diagnosed with HNACC within the SEER database from 2000 to 2023. Disease-specific survival (DSS) and overall survival (OS) were evaluated using diverse statistical methods. Propensity score matching (PSM) reduced covariate variations and selection biases, allowing for comparisons of postoperative and definitive radiotherapy groups.

Results: A total of 2,072 patients were encompassed within this study. The postoperative radiotherapy group yielded significant advantages in OS and DSS (P<0.001). In matched cohorts, the 5-year prognostic OS stood at 55% and 37%, respectively, while DSS figures were 65% and 46%, correspondingly. In advanced T4 cases, DSS differences lacked significance (P=0.42). Additionally, the outcomes of OS and DSS were notably influenced by variables such as T-stage, N-stage, tumor stage, and chemotherapy.

Conclusions: Surgical intervention remains a pivotal component of comprehensive treatment for patients diagnosed with operable HNACC. Definitive radiation is appropriate for less treatable situations, particularly in local advanced HNACC. Systemic treatment may assist HNACC patients at risk of distant metastases.

Keywords: Head and neck cancer; Surveillance, Epidemiology, and End Results database (SEER database); adenoid cystic carcinoma (ACC); definitive radiotherapy; postoperative radiotherapy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-24-1221/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Overview of Kaplan-Meier survival curves for OS and DSS, comparing postoperative radiotherapy and definitive radiotherapy for head and neck adenoid cystic carcinoma. (A) Kaplan-Meier survival curve for OS before PSM. (B) Kaplan-Meier survival curve for DSS before PSM. (C) Kaplan-Meier survival curve for OS after PSM. (D) Kaplan-Meier survival curve for DSS after PSM. OS, overall survival; HR, hazard ratio; CI, confidence interval; DSS, disease-specific survival; PSM, propensity score matching.
Figure 2
Figure 2
Overview of Kaplan-Meier survival curves for OS and DSS in T4 head and neck adenoid cystic carcinoma subgroup comparing postoperative radiotherapy and definitive radiotherapy. (A) Kaplan-Meier survival curve for OS (B) Kaplan-Meier survival curve for DSS. OS, overall survival; HR, hazard ratio; CI, confidence interval; DSS, disease-specific survival.
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