Comparison Of Clinical Efficacy Between Surgery And Combined With Radiotherapy And Analysis Of Prognosis Of Adenoid Cystic Carcinoma Of The Head And Neck

OBJECTIVE: The aim of this study was to observe the curative effect of surgery and surgery +radiotherapy and prognostic factors in ACCHN,and to discuss the optimal treatment for patients tolerated with ACCHN.METHODS: A retrospective analysis of 48 pts with ACCHN who were enrolled in Shenzhen People's Hospital from 2012 to 2018.After using chi-square test to analyze surgery group(16 pts)and surgery + radiotherapy group(32 pts).These 48 pts were all followed up and survival was calculated by using the Kaplan-Meier method.Differences between survival curves in two different groups were analyzed by the log-rank test,and the prognostic analysis was performed by using the Cox regression model.RESULTS: ACCHN is a kind of rare disease but more common in female,likes to occur in salivary gland,has the characteristics of neurotropic invasion and mainly localized in the late stage when patients felt uncomfortable.1-,3-,and 5-year overall survival(OS)rate of the surgery group(16 pts)and the surgery +radiotherapy group(32 pts): 100%?86.2% and 50.3%,100%?92.9% and 88.5%,respectively(P= 0.084).There was a statistically significant difference in 5-year OS between the two groups(P= 0.032).And 1-,3-,and 5-year progression-free survival(PFS): 81.3%?54.2%?15.0%,100%?88.7%?58.9%,respectively.There were statistically significant differences in PFS between the two groups(P = 0.004).Cox regression model showed that tumor maximum diameter ? 3cm,KPS difference ? 20 points,postive margin and distant metastasis were the prognostic factors of OS(P = 0.037?0.006?0.046,0.011),while major salivary gland,tumor maximum diameter ?3cm,T stage,and treatment were the prognostic factors of PFS(P = 0.019?0.020?0.017?0.008).In addition,there was no significant effect on OS and PFS when the radiotherapy dose was divided into two groups by 60 Gy(P = 1.000).Conclusions: Surgery combined with radiotherapy can improve the survival rate and tumor control of patients with ACCHN,especially in patients with local advanced stage.Whether the radiotherapy dose was higher than60 Gy or not,there had no significant impact on overall survival and tumor control(P = 1.000).Tumor maximum diameter ? 3cm,KPS difference ?20 points,postive margin and distant metastasis were the prognostic factors of OS.While major salivary gland,tumor maximum diameter ? 3cm,T stage,and treatment were the prognostic factors of PFS.In conclusion,early diagnosis and improvement of the general functional status of patients are expected to prolongthe survival time of patients with adenoid cystic carcinoma of the head and neck and reduce the possibility of tumor recurrence,especially for patients with local advanced stage who are treated with surgery combined with radiotherapy.