demographic trends and disease-specific survival in salivary acinic cell carcinoma: an analysis of...

The LaryngoscopeVC 2013 The American Laryngological,Rhinological and Otological Society, Inc.

Demographic Trends and Disease-Specific Survival In Salivary

Acinic Cell Carcinoma: An Analysis of 1129 Cases

Neal R. Patel, BS; Saurin Sanghvi, MD; Mohemmed N. Khan, MD; Qasim Husain, MD;

Soly Baredes, MD, FACS; Jean Anderson Eloy, MD, FACS

Objective/Hypothesis: Acinic cell carcinoma (AciCC) is a rare salivary gland malignancy that most commonly arises inthe parotid gland. Characteristics of AciCC are slow growth and a long clinical course. As a rare tumor, population-based stud-ies are limited. We analyzed the incidence and survival for AciCC using a national population-based database.

Study Design: Retrospective analysis.Methods: The United States National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registry was

utilized to calculate incidence and disease-specific survival trends for AciCC between 1973 and 2009. Patient data were strati-fied according to age, gender, race, grade, and extent of disease. Incidence trends were studied across the last 30 years andlong-term disease-specific survival outcomes were compared across the different demographic parameters.

Results: A total of 1,129 cases of AciCC were identified, comprising of 672 (59.52%) females. Incidence trend analysisrevealed significant changes in yearly incidence rates from 1973 to 2009 for male gender and white and “others” races. Over-all 5-year survival was 97.15%, 10-year survival was 93.81%, and 20-year survival was 89.74%. Significant differences in sur-vival outcomes were noted for extent of disease. Patients exhibiting distant metastasis displayed the worse long-termprognosis at 21.99% 20-year disease-specific survival. Hazard ratios demonstrated a significant increase in mortality inpatients with poorly differentiated, undifferentiated, and metastatic disease.

Conclusion: Trends in incidence of AciCC are influenced by gender, race and age. Long-term survival of this rare malig-nant tumor is influenced by gender, grade, race, and extent of disease. Future studies need to be conducted to investigatethese dynamic trends related to AciCC.

Key Words: Acinic cell carcinoma, salivary gland, cancer, malignancy, demographic, incidence, disease-specific survival.Level of Evidence: 2b.

Laryngoscope, 124:172–178, 2014

INTRODUCTIONAcinic cell carcinoma (AciCC) is a rare salivary

gland malignancy that commonly presents as a painlessneck mass. AciCC has a peak incidence in the third tosixth decade of life.1–3 This tumor has been described asa slow-growing malignancy, lending itself to a relativelyhigh survival rate.3 Despite this slow-growth pattern,the asymptomatic nature may lead to late diagnosiswhen more advanced disease is present.1 AciCC is alsoknown for having a protracted course, with recurrencesdecades after initial diagnosis and treatment.4,5 Localrecurrence rates have been reported in previous

literature ranging from 35% to 44% and reports ofmetastases of AciCC have been reported in up to 19% ofpatients.3,4,6 Currently, the preferred method of treat-ment is surgical excision with negative margins.3,7

To our knowledge this is one of the largest standar-dized population-based studies examining disease-specific survival and trends in incidence of AciCC. Hoff-man et. al.,8 previously examined variables associatedwith AciCC. However, that study utilized the NationalCancer Database, a similar but not publicly availabledatabase. The goal of this study was to conduct an anal-ysis of the demographic and disease-specific factorsaffecting the incidence and prognosis of AciCC over thelast 36 years using the United States National CancerInstitute’s Surveillance, Epidemiology, and End Results(SEER) database. Using a separate database with differ-ing patients, this study serves as a complement to theaforementioned analysis.8

MATERIALS AND METHODSThe incidence- and disease-specific survival for AciCC

(ICD Histology Code: 8550) of the salivary glands of the headand neck was extracted using the SEER database from 1973 to2009. The ICD-O-03 topographical coding was utilized for headand neck major salivary glands which included parotid, sub-mandibular, sublingual, and overlapping lesions of major

From the Department of Otolaryngology–Head & Neck Surgery(N.R.P., S.S., M.N.K., Q.H., S.B., J.A.E.), the Center for Skull Base and Pitui-tary Surgery (S.B., J.A.E.), Neurological Institute of New Jersey, Depart-ment of Neurological Surgery (J.A.E.), University of Medicine andDentistry of New Jersey–New Jersey Medical School, Newark,New Jersey, U.S.A

Editor’s Note: This Manuscript was accepted for publication May13, 2013.

The authors have no funding, financial relationships, or conflictsof interest to disclose.

Send correspondence to Jean Anderson Eloy, MD, FACS, AssociateProfessor and Vice Chairman, Director of Rhinology and Sinus Surgery,Department of Otolaryngology–Head and Neck Surgery, UMDNJ-NewJersey Medical School, 90 Bergen St., Suite 8100, Newark, NJ 07103.E-mail: [email protected]

DOI: 10.1002/lary.24231

Laryngoscope 124: January 2014 Patel et al.: Acinic Cell Carcinoma Incidence and Survival

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salivary glands and major salivary glands not otherwise speci-fied. SEER registries 9 and 18 were accessed for incidence andsurvival statistics, respectively. The acquired AciCC data werestratified according to parameters, such as frequency, age atdiagnosis, gender, race, histological grade, and staging. Stagingwas defined as local disease, regional spread, and distantmetastasis, based on the SEER Summary Staging Manual2000.9

The SEER*Stat 8.0.2 program (Surveillance Research Pro-gram, National Cancer Institute, 2013) was used to estimatefrequencies, incidence rates, and relative survival from 1973 to2009. Relative disease-specific survival analysis was extractedto generate 20-year survival data using Kaplan-Meier analysis.The category of “others” within the race demographic includesAmerican Indian, Alaskan Native, Asian/Pacific Islander,unspecified, or unknown. Relative disease-specific survival rateis expressed as the observed rate of survival of patients withdisease after adjusting to the expected survival rate of the pop-ulation in the United States based on the time period anddemographic studied. Incidence rate data were adjusted to theyear 2000 U.S. standard population and was obtained as inci-dence per 100,000 people in the population of study. Multivari-ate analysis was conducted with Cox proportional-hazards ratiowith 95% confidence interval to compare survival among vary-ing demographic groups.

Statistical AnalysisAnalysis was completed using SEER*Stat 8.0.2, Microsoft

Excel Software (Version 2010; Microsoft, Redmont, WA), andJoinpoint Regression Program 3.5.4 (National Cancer Institute,Bethesda, MD). Comparison between survival curves were per-formed using a log-rank test for significance with a P val-ue<0.05. Analyses were computed using JMP StatisticalDiscovery (SAS Institute, Cary, NC).

RESULTS

Demographic AnalysisA total of 1,129 cases of AciCC were reported in the

SEER database between 1973 and 2009. Femalesaccounted for 672 (59.52%) cases and males accountedfor 457 (40.48%) cases, amounting to a 1.47:1 female tomale prevalence ratio (Table I). The database alsoshowed the majority of AciCC tends to occur in people

40 years old and over, with 68% (767) of the casesreported in this age group. A total of 960 (85.03%)patients were white, 89 (7.88%) were “other,” and 80(7.09%) were black. Of the 9,980 cases of salivary glandtumors in the SEER database, there were 1,129 cases ofAciCC reported, making the frequency of AciCC amongall salivary gland tumors 11.42%.

Incidence AnalysisOverall average incidence rate during the 36 years

was 0.13 cases per 100,000 patients per year. The rate ofAciCC was 0.22 cases per 100,000 patients in 2009.There has been a small, though statistically insignifi-cant, increase in incidence from 1973, when the inci-dence was 0.13 cases per 100,000 patients with anannual percentage change (APC) of 0.53% (95%CI:20.2%, 1.2%) (Fig. 1). The highest incidence rate wasexhibited in 2009, while the lowest incidence rate forAciCC was 0.06 cases per 100,000 patients in 1983.

Females exhibited a higher overall average incidencerate during the 36 years, with an average incidence rateof 0.15 cases per 100,000 patients per year. Males had anoverall average incidence rate of 0.11 cases per 100,000patients per year, bringing the overall female-to-maleincidence ratio to 1.36:1. Males displayed an incidencerate of 0.08 cases per 100,000 patients in 1973 and thetrend increased throughout the study period to 0.17 casesper 100,000 patients in 2009. This increase was statisti-cally significant, with an APC of 0.90% (95% CI; 0.2%,1.7%). Females did not exhibit a statistically significantchange in incidence during this same time period. Theincidence rate for females was 0.17 cases per 100,000patients in 1973 and increased to 0.27 cases per 100,000patients in 2009. The APC for the female incidence trendwas 0.39% (95% CI; 20.5%, 1.3%) and did not displayany significant change (Fig. 2).

Incidence rates for race were analyzed, with differen-tiation between blacks, whites, and “others” (Fig. 3).Overall average incidence rate for whites, “others,” andblacks were 0.14, 0.11, and 0.09 cases per 100,000patients per year, respectively. APC for blacks was

TABLE I.Characteristics of Acinic Cell Carcinoma as per the SEER

Database Between 1973 and 2009.

Characteristic No. %

Gender 1,129

Female 672 59.52%

Male 457 40.48%

Age (years)

<55 545 48.27%

>55 584 51.73%

Race

White 960 85.03%

Other 89 7.88%

Black 80 7.09%

SEER 5 surveillance, epidemiology, and end results.

Fig. 1. Joinpoint Analysis of incidence trends of AciCC for theoverall incidence from 1973 to 2009 as rate of AciCC per 100,000(AciCC 5 acinic cell carcinoma; APC 5 annual percentage change).


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26.03% (95% CI; 28.0%, 24.0%) and was statisticallysignificant. “Others” exhibited the most dramatic changein incidence, with an incidence rate as low as 0.04 casesper 100,000 patients in 1990 and as high as 0.34 casesper 100,000 patients in 1988. The associated APC was26.49% (95% CI; 28.4%, 24.6%) and did confirm a statis-tically significant change. The APC for blacks and“others” might be skewed due to the relatively smallnumber of cases in the black and “other” populations incomparison to the white population. Whites exhibitedincidence rates as low as 0.07 cases per 100,000 patientsin 1983 and as high as 0.24 in 2009. Regression analysisof the white incidence trend demonstrated statisticallysignificant change with an APC of 1.06% (95% CI; 0.3%,1.8%).

Incidence of AciCC by age at diagnosis was exam-ined to get a better understanding of which age groupsare most likely affected by this cancer. Patients 60 andabove accounted for 35% of cases and patients 40 to 59accounted for another 33% of the total patients.

Survival AnalysisOverall 20-year survival trends were generated for

patients diagnosed with disease between the years of1973 and 1989 (Fig. 4). The lowest 20-year survival wasobserved for patients diagnosed in 1974, with a long-term survival of 65.76%.

Survival rates were generated for males andfemales (Fig. 5). The 5-, 10-, 15-, and 20-year survivalrates for females were 97.43%, 95.14%, 91.27%, and91.27%, respectively. The 5-, 10-, 15-, and 20-year sur-vival rates for males were 96.26%, 91.74%, 87.72%, and81.54%, respectively. Males had lower survival rates forall time periods. However, this lower survival in maleswas not statistically significant when compared tofemales. Multivariate analysis was conducted to calcu-late hazard ratios (HR) for the purpose of comparingsurvival among the varying patient subsets (Table II). Inthe gender comparison, males were used as the refer-ence and analysis demonstrated that while femalesmade up a greater proportion of the patients, femalepatients were less likely to die of AciCC (HR 5 0.76).

Survival rates were also stratified by race, withcomparison between blacks, whites, and “others” (Fig. 6).The 5-, 10-, 15-, and 20-year survival rates for blackswere 98.94%, 92.42%, 92.25%, and 92.14%, respectively.The white 5-, 10-, 15-, and 20-year survival rates were

Fig. 2. Joinpoint Analysis of gender-specific incidence trends ofacinic cell carcinoma from 1973 to 2009.

Fig. 3. Joinpoint Analysis of race-specific incidence trends ofacinic cell carcinoma from 1973 to 2009 (“others” includes Ameri-can Indian, Alaskan Native, Asian/Pacific Islander, Unspecified, orUnknown).

Fig. 4. Trends in 20-year survival of acinic cell carcinoma for theoverall population diagnosed between 1973 and 1989.

Fig. 5. Trends in gender-specific 20-year survival of acinic cell car-cinoma for the population diagnosed between 1973 and 1989.


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96.71%, 93.45%, 88.96%, and 88.96%, respectively.“Others” displayed 5–, 10–, 15–, and 20-year survivalrates of 98.36%, 96.98%, 88.98%, and 81.57%, respec-tively. Log-rank tests revealed no statistically significantdifference between races. Multivariate analysis was con-ducted using whites as reference. A HR of 5.81 wasfound for “others” and 6.08 was found for blacks.

SEER allows for grading of AciCC among patients.Salivary gland tumors were assigned as well-differentiated, moderately differentiated, poorly differen-tiated, or undifferentiated (anaplastic) (Fig. 7). Following20-year survival for patients with varying grades ofAciCC demonstrated a dramatic decrease in survivalfrom well/moderately differentiated to patients withpoorer histology. Patients with well-differentiatedtumors had 20-year survival rates of 97.79%, andpatients with moderately differentiated tumors stillboasted a relatively high 20-year survival at 83.33%.However, patients with poorly differentiated AciCC had

20-year survival rates of 38.06%, and all patients withundifferentiated histology either died or were censoredin the database before the 20-year period had elapsed.The last available survival rate was 17.96% at 177months (14.75 years). Multivariate analysis allowed forcalculation of HR for the purpose of comparison of rela-tive survival with well/moderately differentiated servingas the reference (Table II). The results demonstratedthat patients with poorly differentiated AciCC were 3times less likely to survive than patients with morefavorable histology. Patients with undifferentiatedtumors were 7.28 times less likely to survive thanpatients with well/moderately differentiated AciCC.

Progression of disease was defined as local disease,regional spread, and distant metastasis. Patients withlocalized disease had 5-, 10-, 15-, and 20-year survivalrates of 100%, 99.15%, 94.91%, and 94.37%, respectively.Patients with regional spread exhibited 5-, 10-, 15-, and20-year survival rates of 82.14%, 78.94%, 76.85%, and72.43%, respectively. Evidence of distant metastasis gave

TABLE II.� � �

Multivariate Analysis Hazard RatioUpper95% CI

Lower95% CI

Gender

Male 1.00 (ref.)

Female 0.76 1.12 0.51

Race

White 1.00 (ref.)

Black 6.08 9.41 4.09

“Others” 5.81 9.00 3.90

Grade

Well/moderately differentiated 1.00 (ref.)

Poorly differentiated 3.00 3.93 2.32

Undifferentiated (anaplastic) 7.28 9.78 5.48

Extent of Disease

Localized 1.00 (ref.)

Regional 4.71 7.23 3.19

Distant 7.50 11.37 5.15

CI 5 confidence interval.

Fig. 6. Trends in race-specific 20-year survival of acinic cell carci-noma for the population diagnosed between 1973 and 1989.

Fig. 7. 5–, 10–, 15–, and 20-year survival for patients with varyinghistological grades of acinic cell carcinoma. [Color figure can beviewed in the online issue, which is available atwileyonlinelibrary.com.]

Fig. 8. 5–, 10–, 15–, and 20-year disease-specific survival trendsby progression of disease at diagnosis. [Color figure can beviewed in the online issue, which is available atwileyonlinelibrary.com.]


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5-, 10-, 15-, and 20-year survival rates of 59.24%,31.52%, 21.99%, and 21.99%, respectively. The differen-ces in survival by extent of disease were found to bestatistically significant (P<0.05) (Fig. 8). HR calcula-tions were conducted using localized disease as the refer-ence. Patients with regional spread and metastaticdisease had HRs of 4.71 and 7.50, respectively.

DISCUSSION

Demographic AnalysisThis study uses the SEER registry to calculate the

frequency, and to examine the trends in survival andincidence for AciCC from 1973 to 2009. AciCC occursmore commonly in females, with a 1.36:1 female-to-maleincidence ratio from 1973 to 2009. This is in accordancewith prior studies describing a greater incidence of vary-ing salivary gland tumors, including AciCC, infemales.10–15 However, the opposite has also beenreported in a previous study by Ellis and Corio.2 Ourresults also indicate a higher incidence of AciCC inwhites over blacks and “others,” a finding also exhibitedin previous studies.12 The frequency of 11.42% found forAciCC among all major salivary gland tumors of thehead and neck is approaching frequency rates found andreported in previous studies.16,17

Incidence AnalysisOverall incidence showed some degree of increase

over the course of 36 years. However, this increaseproved to be statistically insignificant. This slightincrease may be due in part to better reporting to thedatabase in more recent years. However, given that thisincrease is not statistically significant, the incidencerate can be viewed as relatively stable. This rather sta-ble incidence rate is in accordance with previous studies,which have reported a relatively unchanging incidencerate of salivary gland malignancies during this period oftime.12,18

Males had a statistically significant increase in inci-dence from 1973 to 2009. Currently, the only risk factorspositively linked to an increased incidence of salivarygland malignancy is radiation exposure.18,19 Whilefemales did not display a statistically significant changein the incidence of cases over this time period, the inci-dence rate remained higher for females than for malesfor the duration of the study period. This finding is alsosupported by previous literature demonstrating a higherincidence of salivary gland malignancies and AciCC infemales.11,12,20,21 Swanson and Burns22 found a higherincidence of salivary gland cancers in females workingin the hairdressing industry and hypothesized a possiblecorrelation between the development of salivary glandmalignancy and varying chemical exposures. Horn-Rosset. al.23 suggested that hormonal factors may contributeto the gender disparity seen in salivary gland malignan-cies. There have also been hypothesized links betweenthe incidence of salivary gland malignancies and riskfactors such as breast cancer, ultraviolet B (UVB) radia-tion, and exposure to various viruses.24 While there

have not been any positive correlations established,18

further biological and epidemiological studies may pro-vide evidence of possible interactions between differingvariables and the increased risk of salivary glandmalignancies.

Incidence analysis revealed differences whenpatients were stratified by race, with a large predomi-nance of whites (85.03%) affected by AciCC in this study.The difference in incidence between races has been pre-viously studied, showing whites to have a higher inci-dence of salivary gland malignancies,25 includingAciCC.12 The racial bias affecting the incidence of thispathology should be further investigated to provide evi-dence of any regional or genetic influences.

Incidence of AciCC was examined in different agegroups. In this study 35% of the patients were above 60years old, and 68% were above the age of 40. Prior stud-ies of salivary gland malignancies similarly found andincreasing prevalence with age.1,16,26 However, while themajority of patients diagnosed with AciCC are greaterthan 40 years of age, this malignancy does tend to occurat a younger median age than most other salivary glandmalignancies.13

Survival AnalysisTrend analysis of overall long-term survival by year

reveals an initially high survival rate with a slightincrease in survival throughout the last three decades.Survival rate for males with AciCC was 81.54% at 20years. Females demonstrated an even higher 20-yearsurvival rate, with 91.27% of patients alive at 240months after diagnosis. AciCC is a slow-growing malig-nancy with previously reported high-survival rates;3,16

however, long-term 20-year survival for this disease hasnot been reported previously. These high survival ratesare likely a product of the nature of the malignancy,allowing for aggressive surgical resection even yearsafter initial diagnosis. Recurrence of disease has beenreported decades after initial diagnosis and treat-ment.3,4,27 This may be the result of microscopic diseaseafter initial resection. While females did make up agreater number of cases of AciCC, the HR indicates thatfemales were less likely to die of disease (HR 5 0.76),although this HR could have been influenced by areporting bias within the data collection. To our knowl-edge there does not exist any data regarding a protectiveeffect afforded to female gender.

The histological grade of tumors was analyzed andexhibited a dramatic decrease in survival in patientswith histologically aggressive disease. Patients with welland moderately differentiated disease exhibited 20-yearsurvivals of 97.79% and 83.33%, respectively. Patientswith poorly differentiated tumors only had a 20-yearsurvival rate of 38.06%. Patients with undifferentiatedtumors either died of disease or were censored before 20years could elapse. The last available survival rate was17.96% at 177 months. HRs for the varying histologiesalso demonstrate a striking drop in survival. Using well/moderately differentiated AciCC as the reference, HRsindicate that patients with poorly differentiated tumors


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had a 3 times greater risk of dying of disease, andpatients with undifferentiated histology had a 7.28 timesgreater mortality due to disease.

Gomez et. al.5 examined disease-free survival andoverall survival in patients with varying grades of AciCCand the possible utility of adjuvant radiotherapy. Thestudy found that the overall and disease-free survivalwere detrimentally affected by histological characteris-tics of tumor necrosis and elevated/atypical mitoses.5

Other prior studies also acknowledged the existence of aparticularly aggressive, poorly differentiated subgroup ofAciCC with poor prognosis.8,28,29 This is especiallyimportant when considering that AciCC is the second-most common salivary malignancy found in children, forwhom it is desirable to avoid radiation therapy whenpossible.30 The SEER database also bears out the exis-tence of this highly aggressive, undifferentiated sub-group of AciCC, which seems to behave in a much morelethal manner than its more differentiated counterparts.

Disease-specific survival rates of AciCC were alsoanalyzed in accordance with the progression of disease.Patients with localized disease demonstrated a 20-yearsurvival rates of 94.37%. Patients with regional spreadhad significantly lower long-term survival, with 20-yearsurvival rates of 72.43%. Distant metastasis carried thepoorest prognosis, with 20-year survival rates of 21.99%.Differences noted between these groups were found to bestatistically significant. Previous studies have shown anincrease in morbidity and mortality with disseminateddisease.31–33 However, to our knowledge no other studieshave shown 20-year survival curves for patients withvarying progression of disease. Calculation of HRs, usinglocal disease as a reference, indicates that patients withregional spread and metastatic disease had significantlygreater mortality, with HRs of 4.71 and 7.50, respec-tively. This data suggests that earlier detection to pre-vent progression of disease may play a pivotal role infuture mortality and emphasizes the difficulty of eradi-cating disease after metastasis.

The SEER database provides a large-scale standar-dized patient cohort for AciCC with adequate statisticalpower. However, limitations to this study should benoted, including changes to the World Health Organiza-tion histological classification of salivary gland malig-nancies,34 lack of information about chemotherapy, andsurgical margin status. An analysis of the influence ofvarying treatment modalities was not undertaken due toa lack of specific treatment information. Moreover, treat-ment and diagnostic techniques for these patients haveevolved over the past 3 decades. Despite such limita-tions, to our knowledge this study uses one of the largestpatient cohorts to date in order to provide insight toassess the clinical behavior of AciCC.

CONCLUSIONIn this study AciCC had a greater predilection for

females and whites, and its incidence increases withincreasing age. Long-term-survival of AciCC is influ-enced by gender, race, grade, and extent of disease.There are currently no well-defined guidelines for the

use of neoadjuvant/adjuvant radiotherapy. However,radiotherapy has been advocated for use in cases of posi-tive margins after resection, extracapsular extension,presence of tumor necrosis, and high/atypical mitoticactivity.5 A highly aggressive variant of AciCC with poorlong-term survival has been identified in previous stud-ies and was found in the SEER database. Current litera-ture supports the use of radiotherapy in the treatmentof these undifferentiated tumors. Poorer outcomes havealso been associated with patients with distant metasta-sis or undifferentiated histology.

BIBLIOGRAPHY

1. Guimaraes DS, Amaral AP, Prado LF, Nascimento AG. Acinic cell carci-noma of salivary glands: 16 cases with clinicopathologic correlation. JOral Pathol Med 1989;18:396–399.

2. Ellis GL, Corio RL. Acinic cell adenocarcinoma. A clinicopathologic analy-sis of 294 cases. Cancer 1983;52:542–549.

3. Perzin KH, LiVolsi VA. Acinic cell carcinomas arising in salivary glands: aclinicopathologic study. Cancer 1979;44:1434–1457.

4. Lewis JE, Olsen KD, Weiland LH. Acinic cell carcinoma. Clinicopathologicreview. Cancer 1991;67:172–179.

5. Gomez DR, Katabi N, Zhung J, et al. Clinical and pathologic prognosticfeatures in acinic cell carcinoma of the parotid gland. Cancer 2009;115:2128–2137.

6. Yoshida K, Koyama I, Matsui T, Tsukiyama M, Mizushima M. [Acinic celltumor of the bronchial gland]. Nihon Geka Gakkai Zasshi 1989;90:1810–1813.

7. Batsakis JG, Chinn EK, Weimert TA, Work WP, Krause CJ. Acinic cell car-cinoma: a clinicopathologic study of thirty-five cases. J Laryngol Otol1979; 93:325–340.

8. Hoffman HT, Karnell LH, Robinson RA, Pinkston JA, Menck HR. NationalCancer Data Base report on cancer of the head and neck: acinic cell car-cinoma. Head Neck 1999;21:297–309.

9. Young JL. SEER summary staging manual, 2000 : codes and codinginstructions. Bethesda, MD: Dept. of Health and Human Services,National Institutes of Health, National Cancer Institute; 2006.

10. Seifert G, Okabe H, Caselitz J. Epithelial salivary gland tumors in chil-dren and adolescents. Analysis of 80 cases (Salivary Gland Register1965–1984). ORL J Otorhinolaryngol Relat Spec 1986;48:137–149.

11. Ellington CL, Goodman M, Kono SA, et al. Adenoid cystic carcinoma of thehead and neck: incidence and survival trends based on 1973–2007 Sur-veillance, Epidemiology, and End Results data. Cancer 2012;118:4444–4451.

12. Boukheris H, Curtis RE, Land CE, Dores GM. Incidence of carcinoma ofthe major salivary glands according to the WHO classification, 1992 to2006: a population-based study in the United States. Cancer EpidemiolBiomarkers Prev 2009;18:2899–2906.

13. Hoffman HT, Karnell LH, Robinson RA, Pinkston JA, Menck HR. NationalCancer Data Base report on cancer of the head and neck: acinic cell car-cinoma. Head Neck 1999;21:297–309.

14. Sanghvi S, Patel NR, Patel CR, Kalyoussef E, Baredes S, Eloy JA. Sino-nasal adenoid cystic carcinoma: comprehensive analysis of incidence andsurvival from 1973 to 2009. Laryngoscope 2013. doi: 10.1002/lary.24085.[Epub ahead of print].

15. Li N, Xu L, Zhao H, El-Naggar AK, Sturgis EM. A comparison of the dem-ographics, clinical features, and survival of patients with adenoid cysticcarcinoma of major and minor salivary glands versus less common siteswithin the Surveillance, Epidemiology, and End Results registry. Cancer2012;118:3945–3953.

16. Luukkaa H, Klemi P, Leivo I et al. Salivary gland cancer in Finland 1991–1996: an evaluation of 237 cases. Acta Otolaryngol 2005;125:207–214.

17. Vander Poorten VL, Hart AA, van der Laan BF, et al. Prognostic index forpatients with parotid carcinoma: external validation using the nation-wide 1985–1994 Dutch Head and Neck Oncology Cooperative Groupdatabase. Cancer 2003;97:1453–1463.

18. Sun EC, Curtis R, Melbye M, Goedert JJ. Salivary gland cancer in theUnited States. Cancer Epidemiol Biomarkers Prev 1999;8:1095–1100.

19. Boukheris H, Ron E, Dores GM, Stovall M, Smith SA, Curtis RE. Risk ofradiation-related salivary gland carcinomas among survivors of Hodgkinlymphoma: a population-based analysis. Cancer 2008;113:3153–3159.

20. Goldblatt LI, Ellis GL. Salivary gland tumors of the tongue. Analysis of 55new cases and review of the literature. Cancer 1987;60:74–81.

21. Ito FA, Ito K, Vargas PA, de Almeida OP, Lopes MA. Salivary glandtumors in a Brazilian population: a retrospective study of 496 cases. IntJ Oral Maxillofac Surg 2005;34:533–536.

22. Swanson GM, Burns PB. Cancers of the salivary gland: workplace risksamong women and men. Ann Epidemiol 1997;7:369–374.

23. Horn-Ross PL, Morrow M, Ljung BM. Menstrual and reproductive factorsfor salivary gland cancer risk in women. Epidemiology 1999;10:528–530.

24. Nagler RM, Laufer D. Tumors of the major and minor salivary glands:review of 25 years of experience. Anticancer Res 1997;17:701–707.


177

info:doi/10.1002/lary.24085

25. Lee K, Strauss M. Head and neck cancer in blacks. J Natl Med Assoc1994;86:530–534.

26. Ansari MH. Salivary gland tumors in an Iranian population: a retrospec-tive study of 130 cases. J Oral Maxillofac Surg 2007;65:2187–2194.

27. Grage TB, Lober PH, Arhelger SW. Acinic cell carcinoma of the parotidgland. A clinicopathologic review of eleven cases. Am J Surg 1961;102:765–768.

28. Skalova A, Sima R, Vanecek T, et al. Acinic cell carcinoma with high-grade transformation: a report of 9 cases with immunohistochemicalstudy and analysis of TP53 and HER-2/neu genes. Am J Surg Pathol2009;33:1137–1145.

29. Colmenero C, Patron M, Sierra I. Acinic cell carcinoma of the salivaryglands. A review of 20 new cases. J Craniomaxillofac Surg 1991;19:260–266.

30. Cummings CW. Cummings otolaryngology head & neck surgery. Philadel-phia, PA: Elsevier Mosby; 2005.

31. Federspil PA, Constantinidis J, Karapantzos I, Pahl S, Markmann HU, IroH. [Acinic cell carcinomas of the parotid gland. A retrospective analysis].HNO 2001;49:825–830.

32. Laskawi R, Rodel R, Zirk A, Arglebe C. Retrospective analysis of 35patients with acinic cell carcinoma of the parotid gland. J Oral Maxillo-fac Surg 1998;56:440–443.

33. Lin WN, Huang HC, Wu CC, et al. Analysis of acinic cell carcinoma of theparotid gland—15 years experience. Acta Otolaryngol 2010;130:1406–1410.

34. Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Keus RB, Hart AA.Stage as major long term outcome predictor in minor salivary gland car-cinoma. Cancer 2000;89:1195–1204.


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