Patient selection: clinical stage I or II adenoid cystic carcinoma arising in a major salivary gland (= T1 or T2, N0 = palpable mass < 4 cm without soft tissue invasion or palpable lymph nodes)
The lung, liver and skin were the most common sites of distant metastases.
Risk factors for distant metastases on multivariate analysis:
(1) extracapsular spread in a lymph node
(2) solid histologic pattern (not cribiform or tubular)
Additional risk factors from univariate analysis:
(1) lymph node metastases in surgical resection specimen
(2) poorly differentiated (high grade)
where:
• Clinical N0 does not mean pathologic N0.
• Extracapsular tumor spread implies a lymph node metastasis.
• The discussion says that age > 45 years of age was a risk factor but the data in Table 8 suggests that age <= 45 years is a risk factor.
A patient who develops distant metastases has a worse overall and diseaes specific survival.
