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中华胸部外科电子杂志 ›› 2015, Vol. 02 ›› Issue (03) : 168 -173. doi: 10.3877/cma.j.issn.2095-8773.2015.03.006

所属专题: 文献

论著

气管腺样囊性癌的临床治疗经验分析
杨海堂1, 姚烽1, 澹台冀瀓1, 赵洋1, 赵珩1,()   
  1. 1. 200030 上海交通大学附属胸科医院胸外科
  • 收稿日期:2015-06-15 出版日期:2015-08-28
  • 通信作者: 赵珩

Clinical experience in treatment of primary tracheal adenoid cystic carcinoma

Haitang Yang1, Feng Yao1, Jicheng Tantai1, Yang Zhao1, Heng Zhao1,()   

  1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Received:2015-06-15 Published:2015-08-28
  • Corresponding author: Heng Zhao
  • About author:
    Corresponding author: Zhao Heng, Email:
引用本文:

杨海堂, 姚烽, 澹台冀瀓, 赵洋, 赵珩. 气管腺样囊性癌的临床治疗经验分析[J]. 中华胸部外科电子杂志, 2015, 02(03): 168-173.

Haitang Yang, Feng Yao, Jicheng Tantai, Yang Zhao, Heng Zhao. Clinical experience in treatment of primary tracheal adenoid cystic carcinoma[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(03): 168-173.

目的

探讨气管腺样囊性癌(ACC)最佳的合理治疗模式。

方法

回顾性分析1995年1月至2014年12月上海市胸科医院诊治的原发性气管ACC患者的资料。采用Cox多因素回归分析ACC患者总生存期和无病生存期的影响因素。

结果

共109例患者纳入分析,其中男性53例(48.6%),女性56例(51.4%); ACC患者的年龄为21~71岁,平均年龄(46.9±9.0)岁,中位年龄46岁;切除的肿瘤平均直径和气管平均长度分别为(28.9±7.4)mm和(32.9±7.4)mm;总体镜下切端阳性(R1)比例为84.4% (92/109)。所有患者的5年和10年总生存率及无病生存率分别为88.7%和43.2%,及62.0%和20.0%。根据切缘阳性与否以及术后是否进行辅助放疗进一步分组分析:在总生存率方面,切缘阴性未进行术后辅助放疗的患者(R0/0)显著优于切缘阳性并进行术后放疗(R1/1)组以及切缘阳性未进行术后放疗(R1/0)组(χ2=4.410,P=0.036;χ2=8.448,P=0.004);而R1/1组与R1/0组的总生存率比较差异无统计学意义(χ2=1.690,P=0.194)。在无病生存率方面,R0/0组和R1/1组均优于R1/0组(χ2=7.808,P=0.005;χ2=9.907,P=0.002),而R0/0组与R1/1组之间差异无统计学意义(χ2=2.210,P=0.137)。

结论

气管ACC外科切除后生存时间较满意;气管ACC浸润范围广,R0切除率低;R1切除的患者辅助放疗能有效改善预后;手术切除或术后联合放疗可作为较局限的该类气管肿瘤的首选治疗方案。

Objective

To investigate the optimal treatment strategy for primary tracheal adenoid cystic carcinoma(ACC).

Methods

The clinical data of patients with primary tracheal ACC treated between January 1995 and December 2014 in Shanghai Chest Hospital were retrospectively analyzed. Cox multivariate analysis was adopted to investigate the influencing factors of overall survival and disease-free survival in patients with ACC.

Results

A total of 109 patients were identified, including 53 males and 56 females with an average age of (46.9±9.0) years (median 46 years, range 21-71 years). The mean resected tumor size and tracheal length were (28.9±7.4) mm and (32.9±7.4) mm, respectively. Patients with microscopically positive margin accounted for 84.4% (92/109). Five and 10 years overall survival (OS) and disease-free survival (DFS) were 88.7% and 43.2%, and 62.0% and 20.0%, respectively. The overall survival in patients with negative incision margin and no postoperative radiotherapy(R0/0) was significantly higher than that in patients with positive incision margin and postoperative radiotherapy(R1/1) and that in patients with positive incision margin and no postoperative radiotherapy(R1/0)(χ2=4.410, P=0.036; χ2=8.448, P=0.004). However, there was no significant difference in overall survival between R1/1 group and R1/0 group (χ2=1.690, P=0.194). The disease-free survival in R0/0 group and R1/1 group was significantly higher than that in group R1/0 (χ2=1.690, P=0.005; χ2=9.907 P=0.002), while there was no significant difference between R0/0 group and R1/1 group (χ2=2.210, P=0.137).

Conclusions

R1 resection and postoperative radiotherapy can yield favorable outcomes of tracheal ACC, which can serve as the optimal regimen for this disease.

图1 上海市胸科医院1990年至2014年气管恶性肿瘤类型的变化
表1 ACC患者临床资料[例,(%)]
图2 总生存率的Kaplan-Meier生存曲线图
图3 无病生存率Kaplan-Meier生存曲线图
图4 R0/0、R1/1、R1/0三组间总生存率比较(P=0.017)
图5 R0/0、R1/1和R1/0三组间无病生存率比较(P=0.001)
表2 Cox多因素回归分析OS和DFS的影响因素
[1]
Webb BD, Walsh GL, Roberts DB, et al. Primary tracheal malignant neoplasms: the University of Texas MD Anderson Cancer Center experience[J]. J Am Coll Surgeons, 2006,202(2):237-246.
[2]
Xie L, Fan M, Sheets NC, et al. The use of radiation therapy appears to improve outcome in patients with malignant primary tracheal tumors: a seer-based analysis[J]. Int J Radiat Oncol Biol Phys, 2012,84(2):464-470.
[3]
Urdaneta AI, Yu JB, Wilson LD. Population based cancer registry analysis of primary tracheal carcinoma[J]. Am J Clin Oncol, 2011,34(1):32-37.
[4]
Ahn Y, Chang H, Lim YS, et al. Primary tracheal tumors review of 37 cases[J]. J Thorac Oncol,2009,4(5):635-638.
[5]
Gaissert HA, Grillo HC, Shadmehr B, et al. Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina[J]. Ann Thorac Surg,2004,78(6):1889-1896.
[6]
Honings J, Gaissert HA, Weinberg AC, et al. Prognostic value of pathologic characteristics and resection margins in tracheal adenoid cystic carcinoma[J]. Eur J Cardiothorac Surg, 2010,37(6):1438-1444.
[7]
Zhengjaiang L, Pingzhang T, Dechao Z, et al. Primary tracheal tumours: 21 years of experience at Peking Union Medical College, Beijing, China[J]. J Laryngol Otol,2008,122(11):1235-1240.
[8]
Honings J, van Dijck JAAM, Verhagen AFTM, et al. Incidence and treatment of tracheal cancer: a nationwide study in the netherlands[J]. Ann Surg Oncol,2007,14(2):968-976.
[9]
Ogino T, Ono R, Shimizu W, et al. Adenoid cystic carcinoma of the tracheobronchial system: the role of postoperative radiotherapy[J]. Radiat Med, 1995,13(1):27-29.
[10]
Calzada AP, Miller M, Lai CK, et al. Adenoid cystic carcinoma of the airway: a 30-year review at one institution[J]. Am J Otolaryngol,2012,33(2):226-231.
[11]
Maziak DE, Todd TR, Keshavjee SH, et al. Adenoid cystic carcinoma of the airway: Thirty-two-year experience[J]. J Thorac and Cardiovasc Surg,1996,112(6):1522-1531; discussion 1531-1522.
[12]
Macchiarini P. Primary tracheal tumours[J]. Lancet Oncol,2006,7(1):83-91.
[13]
Videtic GM, Campbell C, Vincent MD. Primary chemoradiation as definitive treatment for unresectable cancer of the trachea[J]. Can Respir J,2003,10(3):143-144.
[14]
Nouraei SM, Middleton SE, Nouraei SA, et al. Management and prognosis of primary tracheal cancer: A national analysis[J]. Laryngoscope,2014,124(1):145-150.
[15]
Allen AM, Rabin MS, Reilly JJ, et al. Unresectable adenoid cystic carcinoma of the trachea treated with chemoradiation[J]. J Clin Oncol,2007,25(34):5521-5523.
[16]
Gondivkar SM, Gadbail AR, Chole R, et al. Adenoid cystic carcinoma: a rare clinical entity and literature review[J]. Oral Oncol, 2011,47(4):231-236.
[17]
Lee JH, Jung EJ, Jeon K, et al. Treatment outcomes of patients with adenoid cystic carcinoma of the airway[J]. Lung Cancer, 2011,72(2):244-249.
[18]
Shadmehr MB, Farzanegan R, Graili P, et al. Primary major airway tumors; management and results[J] Eur J Cardiothorac Surg, 2011,39(5):749-754.
[19]
Zhao Y, Zhao H, Fan LM, et al. Adenoid cystic carcinoma in the bronchus behaves more aggressively than its tracheal counterpart[J]. Ann Thorac Surg, 2013,96(6):1998-2005.
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