Abstract
e18150
Background: Adenoid cystic carcinoma (ACC) is a rare malignancy that accounts for 1% of all head and neck malignancies and 10% of salivary gland cancers. The optimal treatment for patients with ACCs of the head and neck is surgery. Previous research into ACC of the head and neck has been limited. Identifying factors that promote or reduce the likelihood of surgery will allow physicians to be aware of disadvantaged patients who still benefit from surgical intervention. Demographic characteristics and surgical treatment of ACC patients were identified and examined using the National Cancer Database (NCDB). Methods: Individuals with a confirmed histological diagnosis of ACC of the head and neck were identified using the NCDB for a retrospective analysis from 2004-2021. Demographics were examined by descriptive statistics, and survival was estimated using Kaplan-Meier curves. Multivariate analyses were performed with Cox Proportional Hazard Regression Models to provide hazard ratios. The effect of Primary Site on Surgery Type was analyzed by multinomial and binomial regressions. Cross-analysis with Pearson Chi-square tests were used to estimate the effect of patient characteristics on receiving or not receiving surgery (Yes/No Surgery). Results: 12,591 patients with ACC of the head and neck were included. No surgery conferred the worst survival, with a mean survival time of 70.036 months. With no surgery as a reference point, the hazard ratio was reduced with surgical treatment. The Lip was more likely to undergo Local Tumor Excision (OR = 12.768), Gum & Other Mouth was more likely for Total/Radical Organ Removal (OR = 3.286), the Mouth Floor and Nose, Nasal Cavity, & Middle Ear were more likely to receive Partial Organ Removal (OR = 3.258; OR = 1.534). All reported odds ratios had p-values < 0.001. All cross-analyses on Pearson Chi-square test yielded a p-value < 0.001. Yes/No Surgery and Race were correlated, 21.9% of Black patients did not receive surgery. 17.8% of White and 18.7% of Other patients did not receive surgery. Age Categories and Yes/No Surgery were correlated. 80+ Year Old patients had less surgery relative to all other Age Categories, with 68.0% of 80+ Year Old patients associated with Surgery. Yes/No Surgery and Insurance were correlated. Not Insured patients were less associated with Surgery (70.4%) relative to all other Insurances. Conclusions: Surgical treatment conferred the greatest survival, reaffirming its critical role in managing ACC. Characteristics that are associated with less surgery include advanced age, Black race, and being uninsured. Notably, this analysis revealed that certain primary sites of ACC are associated with specific surgery types. Further research is necessary to characterize treatment trends and to understand the impact of socioeconomic factors on diagnosis and treatment options.