Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Ann Thorac Surg. 2018 Jun;105(6):1633-1639. doi: 10.1016/j.athoracsur.2018.01.055. Epub 2018 Feb 24.
Primary salivary type lung cancers such as adenoid cystic carcinoma (ACC) and mucoepidermoid carcinoma (MEC) are uncommon primary lung tumors that, given their rarity, remain incompletely understood. This study aimed to characterize the management and outcomes associated with these less common pulmonary malignancies.
Patients in the National Cancer Database diagnosed with primary lung and bronchial (not tracheal) MEC and ACC between 2004 and 2014 were identified. Adjusted mortality risk of surgically managed patients was evaluated in multivariable Cox proportional hazards regression models.
In all, 699 MEC patients and 424 ACC patients were identified. The MEC tumors were smaller (mean size 3.1 cm versus 3.8 cm, p < 0.001), less likely to have lymph node metastases (16% versus 38%, p < 0.001), and less likely to undergo pneumonectomy (9% versus 39%, p < 0.001) compared with ACC. Adjusted Cox models of the surgically managed subset of MEC patients identified high tumor grade (hazard ratio [HR] 3.0, 95% confidence interval [CI]: 1.31 to 7.1, p = 0.01), tumor size greater than 4 cm (HR 6.7, 95% CI: 2.0 to 22.0, p = 0.01), and wedge resection (HR 3.7, 95% CI: 1.1 to 12.0, p = 0.03) to be associated with increased risk of death. For ACC patients, incomplete tumor resection, R1 versus R0 (HR 4.0, 95% CI: 1.5 to 10.6, p = 0.006), and distant metastases (HR 12.6, 95% CI: 2.5 to 64.4, p = 0.002) were associated with increased mortality.
Pulmonary MEC and ACC appear to have distinct physical and oncologic attributes in the National Cancer Database. Although the overall prognosis appears to be favorable, there are subsets of primary salivary type lung cancers with increased mortality risk, and efforts should be made to completely resect these tumors.
腺样囊性癌（ACC）和黏液表皮样癌（MEC）等原发性唾液型肺癌是罕见的原发性肺肿瘤，由于其罕见性，目前仍不完全了解。本研究旨在描述这些较为罕见的肺部恶性肿瘤的治疗方法和预后。
在 2004 年至 2014 年间，从国家癌症数据库中确定了患有原发性肺和支气管（非气管）MEC 和 ACC 的患者。采用多变量 Cox 比例风险回归模型评估接受手术治疗患者的调整后死亡率风险。
共确定了 699 例 MEC 患者和 424 例 ACC 患者。MEC 肿瘤较小（平均大小 3.1cm 与 3.8cm，p<0.001），淋巴结转移的可能性较小（16%与 38%，p<0.001），接受肺切除术的可能性较小（9%与 39%，p<0.001）。与 ACC 相比，接受手术治疗的 MEC 患者亚组的校正 Cox 模型确定了高肿瘤分级（危险比[HR]3.0，95%置信区间[CI]：1.31 至 7.1，p=0.01）、肿瘤大小大于 4cm（HR 6.7，95%CI：2.0 至 22.0，p=0.01）和楔形切除术（HR 3.7，95%CI：1.1 至 12.0，p=0.03）与死亡风险增加相关。对于 ACC 患者，肿瘤不完全切除、R1 与 R0（HR 4.0，95%CI：1.5 至 10.6，p=0.006）和远处转移（HR 12.6，95%CI：2.5 至 64.4，p=0.002）与死亡率增加相关。
在国家癌症数据库中，肺 MEC 和 ACC 似乎具有不同的物理和肿瘤特征。尽管总体预后似乎良好，但仍有一些亚组的原发性唾液型肺癌死亡率风险增加，应努力完全切除这些肿瘤。
