Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Eur J Cardiothorac Surg. 2010 Jun;37(6):1438-44. doi: 10.1016/j.ejcts.2010.01.005. Epub 2010 Mar 30.
We investigate the influence of tumour and resection characteristics on survival in adenoid cystic carcinoma (ACC) of the trachea.
A retrospective study of 12 laryngotracheal, 58 tracheal and 38 carinal resections for primary ACC in 108 consecutive operative survivors between 1962 and 2007 was conducted. Postoperative radiotherapy was administered to 82% of patients (89/108). Depth of invasion, extramural extent, organ invasion, perineural growth, margin status and lymph node involvement were described.
The tumour was intramural in 15% (16/108), extramural in 85% (92/108) and invaded adjacent organs in 20% (22/108). Airway margins were grossly positive in 9 (8%), microscopically positive in 59 (55%) and negative in 40 (37%) of 108 resections. Adventitial (radial) margins of transmural sections were grossly positive in 3 (3%), microscopically positive in 95 (88%) and negative in 10 (9%) cases. Perineural growth was present in 37 (34%) and absent in 12 (11%); it was not observed in 59 (55%) cases. Lymph nodes were positive in 16 (15%) and negative in 45 (42%) cases; it was not sampled in 47 (44%) cases. Median overall survival (OS) and disease-free survival (DFS) for the entire group were 17.7 and 10.2 years, respectively. OS was longer after resection with: negative airway margins (20.4 vs 13.3 years, P=0.028) and negative radial margins (21.7 vs 13.3 years, P=0.050); absence of extramural disease (21.7 vs 13.3 years, P=0.007), perineural growth (22.8 vs 7.5 years, P=0.011) or lymph node metastases (16.8 vs 6.1 years, P=0.017). DFS was longer after resection with: negative airway margins (16.6 vs 9.3, P=0.005) and absence of extramural disease (17.9 vs 9.3 years, P=0.008), perineural growth (17.9 vs 6.6 years, P=0.033) or lymph node metastases (10.2 vs 3.0 years, P=0.005).
After tracheal resection for ACC, limited tumour extent and complete resection are associated with longer overall and disease-free survival. Long-term survival (>10 years), however, is also observed after tracheal resection of locally advanced ACC.
我们研究肿瘤和切除特征对气管腺样囊性癌（ACC）患者生存的影响。
回顾性分析了 1962 年至 2007 年间 108 例连续手术存活的 12 例喉气管、58 例气管和 38 例隆突切除的原发性 ACC 患者。82%（89/108）的患者接受了术后放疗。描述了肿瘤浸润深度、腔外范围、器官侵犯、神经周围生长、边缘状态和淋巴结受累情况。
肿瘤位于管腔内 15%（16/108），位于腔外 85%（92/108），侵犯相邻器官 20%（22/108）。108 例切除标本中，气道边缘大体阳性 9 例（8%），镜下阳性 59 例（55%），阴性 40 例（37%）。穿透性节段的外膜（放射状）边缘大体阳性 3 例（3%），镜下阳性 95 例（88%），阴性 10 例（9%）。神经周围生长 37 例（34%），无神经周围生长 12 例（11%）；59 例（55%）未观察到神经周围生长。淋巴结阳性 16 例（15%），淋巴结阴性 45 例（42%），47 例（44%）未取样。全组患者的中位总生存（OS）和无病生存（DFS）分别为 17.7 年和 10.2 年。以下情况下 OS 较长：气道边缘阴性（20.4 年 vs 13.3 年，P=0.028）和外膜边缘阴性（21.7 年 vs 13.3 年，P=0.050）；无腔外疾病（21.7 年 vs 13.3 年，P=0.007）、神经周围生长（22.8 年 vs 7.5 年，P=0.011）或淋巴结转移（16.8 年 vs 6.1 年，P=0.017）。以下情况下 DFS 较长：气道边缘阴性（16.6 年 vs 9.3 年，P=0.005），无腔外疾病（17.9 年 vs 9.3 年，P=0.008），神经周围生长（17.9 年 vs 6.6 年，P=0.033）或淋巴结转移（10.2 年 vs 3.0 年，P=0.005）。
气管 ACC 切除后，肿瘤范围有限且完全切除与总生存和无病生存时间延长有关。然而，气管局部晚期 ACC 切除后也观察到长期生存（>10 年）。
