Abstract
BACKGROUND: This study evaluated the clinical outcomes of the patients with adenoid cystic carcinoma (ACC) of the minor salivary glands of the palate. METHODS: Forty-four patients with stage I-II disease and 14 patients with stage III-IV disease underwent radical excision and reconstruction with a facial-submental artery island flap (FSAIF) and titanium mesh plus a free anterolateral thigh flap (ALTF) and radiotherapy respectively. Patients with stage III-IV disease subsequently received cobalt Co 60 adjuvant radiotherapy. Ki-67 expression was determined semiquantitatively in 52 patients with ACC by based on the cytoplasm staining intensity and percentage of positively stained tumor cells. RESULTS: The median (range) follow-up was 32.9 (14-58) months. Forty-one (71.7%) patients survived without disease recurrence. Nine patients (15.5%) survived with recurrent tumors (four with local recurrence, three with regional recurrence requiring salvage surgery, and two with distant metastasis); among these patients, five had overlapping recurrence. Eight patients (13.8%) died of regional, distant, or multiorgan metastasis (range: 22-42 months). The overall median (95% CI) survival time was 32.5 (25.0-39.5) months, and the median (95% CI) progression-free survival time was 32.9 (28.5-36.9) months. Rates of survival and recurrence differed significantly between patients with low- and high-grade tumors, patients with clinical stage I-II disease and those with stage III-IV disease, patients with and without lymph node metastasis, patients who underwent radical excision with versus without radiotherapy, and patients with low and high Ki-67 expression. CONCLUSION: Radical resection and reconstruction with FSAIF is suitable methods for the the treatment of stage I-II ACC of the minor salivary glands of the palate. Stage III-IV tumors require radical resection, reconstruction with titanium mesh and free ALTF, and radiotherapy.