Abstract
Purpose :
To evaluate the status of Vascular Endothelial Growth Factor-A (VEGF-A) in lacrimal gland Adenoid cystic carcinoma (ACC) and to correlate with high risk clinicopathological features.
Methods :
A retrospective analysis of 30 histopathologically proven ACC patients was undertaken. Clinicopathological features were recorded & 1-55 months follow up was available. TNM staging was done (AJCC, 8thedition). VEGF-A expression was evaluated by immunohistochemisty (IHC) (clone VG1). The association between VEGF-A and clinicopathological variables was analysed using Fisher’s exact test; survival by Kaplan-Meier and statistical analysis using log-rank test. Cox regression was performed to determine its prognostic significance.
Results :
Of the 30 ACC cases, there were 15 females and males respectively with a mean age of 38±25.8 years. Large tumor size (>2 cm) was found in 86.6% (26/30) cases. The growth pattern was cribriform (n=16), solid (n=9) and mixed (n=5). Perineural invasion was present in 33.3% (10/30), intracranial extension in 16.6% (5/30) & bone erosion in 33.3% (10/30) cases. Exenteration was performed in 23.3% (7/30). Recurrence developed in 60% (18/30), systemic metastasis and death both in 20% (6/30) cases. VEGF-A overexpression was seen in 46.6% (14/30) cases. Clinicopathological correlation revealed VEGF-A to be significantly associated with solid histologic pattern (p=0.04) and intracranial extension (p=0.01). On Kaplan-Meier analysis, expression of VEGF-A (p=0.002), solid histologic pattern (p=0.004), perineural invasion (p=0.003), bone erosion (p= 0.000), T3-T4 stage (p= 0.004), intracranial extension (p= 0.01) and exenteration (p=0.01) significantly correlated with reduced disease free survival. Univariate analysis showed significant correlation of VEGF-A overexpression, solid histologic pattern, perineural invasion, bone erosion, T3-T4 stage, intracranial extension, exenteration and metastasis. On multivariate analysis VEGF-A (HR: 15.2, 95% CI: 1.9-119.4, p=0.010) and bone erosion (HR: 21.0, 95% CI: 1.7-247.8, p=0.015) were found significant prognostic factors along with metastasis (HR: 5.3, 95% CI: 1.0-26.8, p=0.04).
Conclusions :
Overexpression of VEGF-A along with bone erosion and metastasis are all important poor prognostic factors in the outcome of lacrimal gland ACC. Studies on a larger cohort is necessary to further validate VEGF-A as a potential therapeutic target in the management of lacrimal gland ACC.
This is a 2021 ARVO Annual Meeting abstract.