Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, People's Republic of China.
Ann Thorac Surg. 2013 Dec;96(6):1998-2004. doi: 10.1016/j.athoracsur.2013.08.009. Epub 2013 Oct 3.
Primary airway adenoid cystic carcinomas (ACCs) are rare neoplasms and challenging to resect completely. The objective of the current study was to evaluate clinical and pathologic features and indicate prognostic factors based on different tumor locations in the airway.
From March 2001 to April 2012, 82 consecutively operated patients were enrolled in this study with pathologically confirmed airway adenoid cystic carcinomas in the Shanghai Chest Hospital. Clinical and pathologic data were retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier and log-rank tests. Multivariate analysis was performed using the Cox regression model.
The ACCs originating from the bronchus were associated with older age (p = 0.021), had fewer positive margins (44.8% vs 84.9%, p < 0.001), and more involved lymph nodes (55.2% vs 14.3%, p = 0.002) than their tracheal counterparts. The overall survival after resection of all ACCs was 90.6% at 5 years and 56.4% at 10 years. Five and 10-year disease-free survival was 66.9% and 11.2%, respectively. Multivariate analysis indentified only dyspnea as a presenting symptom to predict tracheal disease-free survival (hazard ratio = 0.062, 95% confidence interval = 0.005 to 0.785, p = 0.032). Bronchial ACCs had worse disease-free survival than tumors of tracheal origin (p = 0.001).
Adenoid cystic carcinoma in the bronchus behaves more aggressively than its tracheal counterpart. Only dyspnea as a presenting symptom predicts better disease-free survival after resection of tracheal ACCs.
原发性气道腺样囊性癌（ACC）是一种罕见的肿瘤，很难完全切除。本研究的目的是评估基于气道不同部位的临床和病理特征，并指出预后因素。
2001 年 3 月至 2012 年 4 月，上海胸科医院连续收治 82 例经病理证实的气道腺样囊性癌患者。回顾性分析临床和病理资料。采用 Kaplan-Meier 和对数秩检验进行生存分析。采用 Cox 回归模型进行多因素分析。
起源于支气管的 ACC 与年龄较大有关（p=0.021），切缘阳性率较低（44.8%比 84.9%，p<0.001），淋巴结受累率较高（55.2%比 14.3%，p=0.002）。所有 ACC 切除后的总生存率为 5 年 90.6%，10 年 56.4%。5 年和 10 年无病生存率分别为 66.9%和 11.2%。多因素分析仅发现呼吸困难作为首发症状可预测气管无病生存率（风险比=0.062，95%置信区间=0.005~0.785，p=0.032）。支气管 ACC 的无病生存率较气管起源肿瘤差（p=0.001）。
支气管的腺样囊性癌比气管的表现更具侵袭性。只有呼吸困难作为首发症状可预测气管 ACC 切除后的无病生存率更好。
