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Salivary duct carcinoma: Clinical outcomes and prognostic factors in 157 patients and results of androgen deprivation therapy in recurrent disease (n=31)—Study of the Dutch head and neck society (DHNS).
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2016
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Surgical OncologyCancer ManagementGynecologyPathologySalivary Duct CarcinomaSalivary GlandGynecology OncologyOral CancerOncologyClinical OutcomesNeck OncologyDiagnostic SciencesRadiation OncologyCancer ResearchHealth SciencesRecurrent SdcCancer DiagnosisMedian OsEndocrine-related CancerRecurrent PtsHead And Neck CancerMedicineDutch Head
6016 Background: Salivary Duct Carcinoma (SDC) is a rare, highly aggressive subtype of salivary gland cancer, which is androgen receptor (AR) positive in most pts. In recurrent disease androgen deprivation therapy (ADT) can be used, however only limited data are available. The aim of this study was to evaluate clinical outcome, to identify prognostic factors for overall survival (OS) and to retrospectively analyze efficacy of ADT. Methods: The nationwide network and registry of histo- and cytopathology (PALGA) identified all adult pts with SDC between 1990 - 2014 in the Netherlands. Lymph node ratio (LNR) was defined as the number of positive LN divided by the total number of LN after neck dissection. Survival analyses were conducted using Kaplan-Meier method. The Cox proportional hazard model was used to identify prognostic factors on uni- and multivariable analyses. Results: A total of 157 pts with SDC were identified. Median age was 66 years, 77% were male. AR and HER2neu were positive in 100% and 44%, respectively. Median number of positive LN was 4 (range 0–97) and median LNR was 0.20. Median OS was 44 months (95% CI 30-48). Multivariable analyses identified male gender, high N-stage and high LNR as significant poor prognostic factors for OS. After median 14 months (range 1-87) 84 pts (54%) had recurrent disease: local recurrence in n = 19 (23%), regional recurrence in n = 31 (37%) and distant metastases in n = 72 (86%). Only 12 (14%) of recurrent pts had local and/or regional recurrence without distant metastases. 31 pts with recurrent SDC were treated with ADT: 4 pts had PR, 10 pts had SD and 17 pts had PD. Median PFS of all ADT treated pts was 3.8 months (range 1-25) and median OS 4 months (range 1–64). In pts with PR or SD (45%) median PFS was 11 months (range 3-25) and median OS was 29 months (range 3-64). Conclusions: More than half of the SDC pts developed recurrent disease. Male gender, high N-stage and high LNR were correlated with worse OS. In this largest series of ADT treated SDC pts, we found clinical benefit (PR + SD) in 45% of pts for a median duration of 11 months and median OS of 29 months. We recommend considering ADT treatment in recurrent SDC.