Histological-pathological and clinical T stage of primary adenoid cystic carcinoma of the lacrimal gland in a Chinese population
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Background
To present clinical presentations, histological-pathological patterns, clinical T stage, divergent treating methods, and outcomes of primary adenoid cystic carcinoma (ACC) of the lacrimal gland in a Chinese population.
Methods
This case series included patients with primary lacrimal gland adenoid cystic carcinoma treated at a Chinese hospital between 2003 and 2014. An exploratory multivariate Cox regression analysis was performed to evaluate the prognostic impact of clinical T-stage. Subsequently, Kaplan–Meier survival analysis was conducted, stratifying patients by T-stage (T4 vs. T1–T3) and by surgical approach among T4 patients, to assess the influence of tumor stage and surgical management on disease-free survival outcomes.
Results
A total of 38 patients included 16 men and 22 women with a median age of 46.3 years were enrolled. Sixteen patients (42.11%) had local recurrence, while nineteen patients (50%) had distant metastasis at the time of presentation. Twelve patients (31.58%) were in T1-T3 stage and twenty-six (68.42%) were in T4 stage. Nineteen patients (73.08%) in the T4 stage exhibited a predominantly solid-basaloid pattern, and only three (25%) in T1-T3 stage had a predominantly solid-basaloid pattern histological pattern. Median DFS for the entire cohort was 29.0 months (95% CI, 19.0–39.0), and median survival after metastasis was 7.0 months (95% CI, 3.0–9.0). After adjustment for covariates, T4 stage remained independently associated with significantly shorter DFS (HR = 4.46, 95% CI: 1.40-14.21, P = 0.011). A significant difference in DFS was observed between the T1–T3 and T4 groups (log-rank P = 0.003). Meanwhile, no significant difference in disease-free survival was observed between T4 patients undergoing globe-preserving surgery and eye-sparing approaches (log-rank P = 0.297).
Conclusions
In this Chinese cohort, the solid-basaloid pattern correlated strongly with advanced T4 disease and aggressive behavior. Kaplan–Meier and multivariate Cox analyses consistently demonstrated that T4 stage was independently associated with significantly poorer DFS. For T4 patients, DFS did not differ significantly between exenteration and globe-preserving surgery when combined with radiotherapy, suggesting that eye-sparing approaches may be viable in advanced cases.
