American Joint Committee on Cancer Classification Predicts Outcome of Patients with Lacrimal Gland Adenoid Cystic Carcinoma

Purpose: To investigate whether American Joint Committee on Cancer (AJCC) classification at initial diagnosis of lacrimal gland adenoid cystic carcinoma predicts outcome of treatment on local recurrence. Design: Retrospective chart review. Participants: Consecutive patients with adenoid cystic carcinoma of the lacrimal gland treated at 8 institutions between January 1986 and December 2007. Methods: Clinical records, including pathology reports and imaging studies, were reviewed. Main Outcome Measures: AJCC classification, histologic subtype, local recurrence rate, and survival. Results: AJCC classification at initial diagnosis was assessable for 53 patients and was as follows: T1N0M0, 7 patients; T2N0M0, 8 patients; T3aN0M0, 14 patients; T3aNxM0, 1 patient; T3aN0M1, 1 patient; T3bN0M0, 13 patients; T3bN0M1, 1 patient; T4aN0M0, 2 patients; T4bN0M0, 4 patients; T4bN0M1, 1 patient; and T4bNXM0, 1 patient. Thirty-eight (72%) of the 53 patients had >T3 tumors at presentation. Of the 38 patients with >T3 tumors, 20 were treated with orbital exenteration and postoperative adjuvant radiotherapy (RT), 6 were treated with orbital exenteration without RT, and 12 were treated with globe-preserving surgery (10 with RT and 2 without RT). Of the 15 patients with <T3 tumors, 6 were treated with globe-preserving surgery and RT, 2 were treated with globe-preserving surgery without RT, 6 were treated with orbital exenteration with bone removal and RT, and 1 was treated with orbital exenteration with bone removal without RT. Only 1 patient with a <T3 tumor, had local recurrence. Among patients with >T3 tumors, the risk of local recurrence (in the orbit or skull base) was higher in patients treated with conservative surgery as opposed to orbital exenteration and RT. Only 4 (20%) of the 20 patients treated with orbital exenteration and RT had local recurrence, compared with 3 (50%) of the 6 patients treated with orbital exenteration without RT and 8 (67%) of the 12 patients treated with globe-preserving surgery. Overall, 17 (45%) of the 38 patients with >T3 tumors and only 1 (7%) of the 15 patients with <T3 tumors died of disease during the study period. Conclusions: In patients with lacrimal gland adenoid cystic carcinoma, AJCC >T3 disease at initial diagnosis correlates with worse outcomes than does AJCC <T3 disease. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.