Clinical experience in treatment of primary tracheal adenoid cystic carcinoma

doi:10.3877/cma.j.issn.2095-8773.2015.03.006

Abstract

Abstract:

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.

Key words: Tracheal adenoid cystic carcinoma, Surgery, Margin, Radiotherapy, Survival

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.

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References 19

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指标		总体情况(109例)
年龄(±s，岁)		46.9±9.0
性别		?
?	男性	53(48.6)
?	女性	56(51.4)
切除肿瘤直径(±s, mm)		28.9±7.4
切除气管长度(±s, mm)		32.9±7.4
切缘		?
?	R0	17(15.6)
?	R1	92(84.4)
随访^a		?
?	R0	10(12.0)
?	R1	73(88.0)
放疗		?
R0＋R1		?
?	是	61(73.5)
?	否	22(26.5)
R1^b		?
?	是	61(83.6)
?	否	12(16.4)
死亡		1(0.9)
非致死性并发症^c		24(24.5)

指标		总体情况(109例)
年龄(±s，岁)		46.9±9.0
性别		?
?	男性	53(48.6)
?	女性	56(51.4)
切除肿瘤直径(±s, mm)		28.9±7.4
切除气管长度(±s, mm)		32.9±7.4
切缘		?
?	R0	17(15.6)
?	R1	92(84.4)
随访^a		?
?	R0	10(12.0)
?	R1	73(88.0)
放疗		?
R0＋R1		?
?	是	61(73.5)
?	否	22(26.5)
R1^b		?
?	是	61(83.6)
?	否	12(16.4)
死亡		1(0.9)
非致死性并发症^c		24(24.5)

因素	DFS			OS
因素	HR (95% CI)	回归系数(B)	P值	HR (95% CI)	回归系数(B)	P值
性别(女性vs男性)	0.50(0.25～0.99)	－0.69	0.047	0.55(0.26～1.20)	－0.60	0.129
年龄(≥47岁vs <47岁)	0.98(0.52～1.84)	－0.02	0.940	0.92(0.42～1.99)	－0.09	0.824
切除肿瘤直径(≥29 mm vs <29 mm)	1.35(0.73～2.49)	－0.30	0.344	0.93(0.44～1.95)	－0.08	0.838
切缘(R1 vs R0)	4.07(1.18～14.07)	－1.40	0.026	5.97(1.16～30.70)	－1.79	0.032
放疗(是vs否)	0.33(0.14～0.77)	－1.11	0.010	0.24(1.37)	－0.57	0.206

因素	DFS			OS
因素	HR (95% CI)	回归系数(B)	P值	HR (95% CI)	回归系数(B)	P值
性别(女性vs男性)	0.50(0.25～0.99)	－0.69	0.047	0.55(0.26～1.20)	－0.60	0.129
年龄(≥47岁vs <47岁)	0.98(0.52～1.84)	－0.02	0.940	0.92(0.42～1.99)	－0.09	0.824
切除肿瘤直径(≥29 mm vs <29 mm)	1.35(0.73～2.49)	－0.30	0.344	0.93(0.44～1.95)	－0.08	0.838
切缘(R1 vs R0)	4.07(1.18～14.07)	－1.40	0.026	5.97(1.16～30.70)	－1.79	0.032
放疗(是vs否)	0.33(0.14～0.77)	－1.11	0.010	0.24(1.37)	－0.57	0.206

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