Zhu D C, Xu J H, Zhang M H, Zhu H X, Zhang Y, Zhang T, Xu G R
Department of Oncology, Shanghai Pudong New Area People's Hospital, Pudong New Area, Shanghai 201299, China.
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430024, China.
Zhonghua Zhong Liu Za Zhi. 2018 Nov 23;40(11):864-868. doi: 10.3760/cma.j.issn.0253-3766.2018.11.013.
To explore the clinical value of endoscopic interventional therapy for locally recurrent primary lung adenoid cystic carcinoma (ACC). The clinical data of 42 patients with locally recurrent ACC were retrospectively analyzed, and the differences of tracheal and bronchial diameter, airway scoring grade and airway obstruction degree before and after treatment were compared among three treatment methods: bronchoscopic interventional therapy + palliative radiotherapy, interventional therapy alone, and non-interventional therapy. Log rank test and Cox proportional risk model multi-factor analysis were used to determine the prognostic factors of ACC patients with local recurrence, and the long-term effect of bronchoscopic interventional therapy on ACC with local recurrence was determined. The median overall survival of 42 patients was 59 months and 5-year survival rate was 54.2%.Univariate analysis showed that vascularized cancer, pleural invasion, pulmonary atelectasis, incisal margin, microscopic classification, tumor diameter, initial TNM stage, ki-67 index, and treatment after local recurrence were associated with long-term survival of ACC patients with local recurrence (all <0.05). Cox multivariate regression analysis showed that margin status (=0.272, =0.011), tumor diameter (=2.586, =0.005), initial TNM staging (=0.369, =0.035), ki-67 index (=3.569, <0.001), and treatment methods after local recurrence (=0.126, <0.001) were independent factors influencing the prognosis of ACC patients with local recurrence. After three months of treatment, the tracheal bronchus diameters, rating of shortness of breath, and degree of airway obstruction were all improved significantly (all <0.05), both in the interventional therapy + palliative radiotherapy group [(14.5±2.8 mm, 0.86±0.45, (14.50±10.67)%, respectively], and the interventional therapy alone group [(13.7±2.3) mm, 0.97±0.25, (15.38±12.02)%, respectively]. Meanwhile, the difference before and after non-interventional therapy was not statistically significant (all >0.05). 5-year overall survival rates were 55.8%, 46.6% and 42.6% for patients undergoing interventional therapy+ palliative radiotherapy, interventional therapy alone, and non-interventional therapy after recurrence, with statistically significant differences (=0.015). Patients underwent bronchial endoscopic interventional therapy and palliative radiotherapy had the best efficacy of treatment. Endoscopic interventional therapy plus palliative radiotherapy is an effective local palliative treatment for locally recurrent ACC patients, which can rapidly relieve airway stenosis, improve the quality of life of patients and prolong the survival time of patients.
探讨内镜介入治疗对局部复发性原发性肺腺样囊性癌（ACC）的临床价值。回顾性分析42例局部复发性ACC患者的临床资料，比较支气管镜介入治疗+姑息性放疗、单纯介入治疗和非介入治疗三种治疗方法治疗前后气管和支气管直径、气道评分等级及气道阻塞程度的差异。采用Log rank检验和Cox比例风险模型多因素分析确定局部复发性ACC患者的预后因素，明确支气管镜介入治疗对局部复发性ACC的长期疗效。42例患者的中位总生存期为59个月，5年生存率为54.2%。单因素分析显示，血管化癌、胸膜侵犯、肺不张、切缘、显微镜下分类、肿瘤直径、初始TNM分期、ki-67指数及局部复发后的治疗与局部复发性ACC患者的长期生存相关（均<0.05）。Cox多因素回归分析显示，切缘状态（=0.272，=0.011）、肿瘤直径（=2.586，=0.005）、初始TNM分期（=0.369，=0.035）、ki-67指数（=3.569，<0.001）及局部复发后的治疗方法（=0.126，<0.001）是影响局部复发性ACC患者预后的独立因素。治疗3个月后，介入治疗+姑息性放疗组[分别为（14.5±2.8）mm、0.86±0.45、（14.50±10.67）%]和单纯介入治疗组[分别为（13.7±2.3）mm、0.97±0.25、（15.38±12.02）%]的气管支气管直径、气短评分及气道阻塞程度均显著改善（均<0.05）。同时，非介入治疗前后差异无统计学意义（均>0.05）。复发后接受介入治疗+姑息性放疗、单纯介入治疗和非介入治疗的患者5年总生存率分别为55.8%、46.6%和42.6%，差异有统计学意义（=0.015）。接受支气管内镜介入治疗和姑息性放疗的患者治疗效果最佳。内镜介入治疗联合姑息性放疗是局部复发性ACC患者有效的局部姑息治疗方法，可迅速缓解气道狭窄，提高患者生活质量，延长患者生存时间。
