Adenoid cystic carcinoma: Use of cell proliferation, BCL-2 expression, histologic grade, and clinical stage as predictors of clinical outcome

• Published in: Head & neck Vol. 22; no. 5; pp. 489 - 497
• Main Authors: Norberg-Spaak, Lena, Dardick, Irving, Ledin, Torbjörn
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01.08.2000; John Wiley & Sons
• Subjects: Adult; Aged; Aged, 80 and over; Antigens, Nuclear; Apoptosis - genetics; Biological and medical sciences; Biomarkers, Tumor - analysis; Carcinoma, Adenoid Cystic - genetics; Carcinoma, Adenoid Cystic - pathology; Carcinoma, Adenoid Cystic - secondary; Carcinoma, Adenoid Cystic - surgery; Cause of Death; Cell Cycle - genetics; Cell Division; Chi-Square Distribution; clinical outcome; Disease-Free Survival; Ent. Stomatology; Female; Follow-Up Studies; Forecasting; Gene Expression Regulation, Neoplastic; Genes, bcl-2 - genetics; grading and stage; Head and Neck Neoplasms - genetics; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Humans; Investigative techniques, diagnostic techniques (general aspects); Ki-67 Antigen; Male; Medical sciences; MEDICIN; MEDICINE; Middle Aged; Neoplasm Recurrence, Local - genetics; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Nuclear Proteins - analysis; Nuclear Proteins - genetics; Otorhinolaryngology. Stomatology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; proliferation; Proto-Oncogene Proteins c-bcl-2 - analysis; Proto-Oncogene Proteins c-bcl-2 - genetics; salivary gland tumors; Treatment Outcome; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Human; Histological grading; Immunohistochemistry; Stomatology; Stage classification; Biological marker; Exploration; Salivary gland; Malignant tumor; Pathology; Symptomatology; Salivary gland disease; ENT disease; Adult; Diagnosis; Predictive factor; Adenoid cystic carcinoma; Comparative study
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/1097-0347(200008)22:5<489::AID-HED8>3.0.CO;2-X

Background Although the three basic histologic growth patterns of adenoid cystic carcinomas (tubular, cribriform, and solid) provide some indication of clinical outcome, additional, perhaps superior, predictors of biologic activity are needed for patient management. Methods This series is composed of 31 adenoid cystic carcinomas that presented in Linköping between 1982 and 1997. The tumors were clinically staged and histologically graded. For each case, after immunohistochemical identification, the proportion of tumor cells expressing the cell cycle markers MIB‐1 and bcl‐2 (as an indicator of proliferation and apoptosis, respectively) were quantified. Statistical correlation was sought between tumor stage and grade and the two cell cycle markers. Results The proportions of cycling tumor cells in adenoid cystic carcinomas ranged from 0.3% to 55%. For patients with no evidence of disease and a follow‐up of at least 5 years, the mean percent MIB‐1 value was significantly lower than for those patients who were alive with local recurrence and/or metastasis or who had died from their adenoid cystic carcinoma (p = .024). MIB‐1 tumor cell positivity also correlated strongly with tumor grade (p = .053), but not with stage (p = .22). Neither clinical stage nor histologic grade correlated with the degree of bcl‐2 tumor cell positivity (p = .97 and p = .49, respectively). Conclusions Staging and grading continue to play a vital role in the management of patients with adenoid cystic carcinoma. Furthermore, in this series of patients with adenoid cystic carcinoma, a cycling tumor cell population as measured by the MIB‐1 antibody greater than 10% indicates this group as biologically more aggressive and at an increased risk for a fatal course. © 2000 John Wiley & Sons, Inc. Head Neck 22: 489–497