Prognostic Value of Tumor Volume Doubling Time in Lung-Metastatic Adenoid Cystic Carcinoma

Authors

Eduardo A Dal Lago
Luana G Sousa
Zixi Yang
Camilla O Hoff
Flavia Bonini
Matthew Sawyer
Kaiwen Wang
Whitney Lewis
Kareem A Wahid
Ehab Y Hanna
Adel El-Naggar
Clifton D Fuller
Suprateek Kundu
Myrna Godoy
Renata Ferrarotto

Publication Date

4-1-2024

Journal

Oral Oncology

Abstract

Objectives: Lung metastases in adenoid cystic carcinoma (ACC) usually have indolent growth and the optimal timing to start systemic therapy is not established. We assessed ACC lung metastasis tumor growth dynamics and compared the prognostic value of time to progression (TTP) and tumor volume doubling time (TVDT).

Methods: The study included ACC patients with ≥1 pulmonary metastasis (≥5 mm) and at least 2 chest computed tomography scans. Radiology assessment was performed from the first scan showing metastasis until treatment initiation or death. Up to 5 lung nodules per patient were segmented for TVDT calculation. To assess tumor growth rate (TGR), the correlation coefficient (r) and coefficient of determination (R2) were calculated for measured lung nodules. TTP was assessed per RECIST 1.1; TVDT was calculated using the Schwartz formula. Overall survival was analyzed using the Kaplan-Meier method.

Results: The study included 75 patients. Sixty-seven patients (89%) had lung-only metastasis on first CT scan. The TGR was overall constant (median R2 = 0.974). Median TTP and TVDT were 11.2 months and 7.5 months. Shorter TVDT (<6 months) was associated with poor overall survival (HR = 0.48; p = 0.037), but TTP was not associated with survival (HR = 1.02; p = 0.96). Cox regression showed that TVDT but not TTP significantly correlated with OS. TVDT calculated using estimated tumor volume correlated with TVDT obtained by segmentation.

Conclusion: Most ACC lung metastases have a constant TGR. TVDT may be a better prognostic indicator than TTP in lung-metastatic ACC. TVDT can be estimated by single longitudinal measurement in clinical practice.

Keywords

Humans, Prognosis, Carcinoma, Adenoid Cystic, Tumor Burden, Time Factors, Lung Neoplasms, Lung, Retrospective Studies, Adenoid cystic carcinoma, Neoplasm metastasis, Response evaluation criteria in solid tumors, Progression-free survival, Tumor burden

DOI

10.1016/j.oraloncology.2024.106759

PMID

38507991

PMCID

PMC11195296

PubMedCentral® Posted Date

4-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes