Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California; Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina; Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 2020 Apr;109(4):1026-1032. doi: 10.1016/j.athoracsur.2019.08.094. Epub 2019 Oct 4.
Achieving negative margins for adenoid cystic carcinoma (ACC) of the trachea can be technically difficult. This study evaluated the impact of positive margins on prognosis and tested the hypothesis that radiation improves survival in the setting of incomplete resection.
The impact of margin status and adjuvant therapy on overall survival of patients with tracheal ACC in the National Cancer Database (1998 to 2014) who underwent resection with known margin status and with no documented nodal or distant disease was evaluated using Kaplan-Meier and Cox proportional hazard analysis.
Of 132 patients who met study criteria, 79 (59.8%) had positive margins after resection. Adjuvant radiation was given to 95 patients overall (72.0%) and to 62 of the 79 patients with positive margins (78.5%). The survival of patients with positive margins was not significantly different from that of patients with negative margins (5-year survival, 82.2% [95% confidence interval (CI), 71.3-89.3] compared with 82.0% [95% CI, 67.0-90.6], P = .97), even after multivariable adjustment (hazard ratio, 1.73; 95% CI, 0.62-4.84; P = .30). In the subset of patients with positive margins, there was no significant difference in survival between patients who did or did not receive postoperative radiation therapy (5-year survival, 82.0% [95% CI, 68.8-89.9] compared with 82.4% [95% CI, 54.7-93.9]; P = .80), even after multivariable adjustment (hazard ratio, 1.04; 95% CI, 0.21-5.25; P = .96).
The majority of tracheal ACC resections performed in this national cohort had positive margins. Adjuvant radiation was commonly used for positive margins but was not associated with an overall survival benefit.
对于气管腺样囊性癌（ACC），实现阴性切缘可能具有一定难度。本研究评估了阳性切缘对预后的影响，并验证了假设，即对于不完全切除的患者，放疗可改善生存。
通过 Kaplan-Meier 分析和 Cox 比例风险分析，评估了国家癌症数据库（1998 年至 2014 年）中已知切缘状态且无记录的淋巴结或远处疾病的接受切除术的气管 ACC 患者的切缘状态和辅助治疗对总生存的影响。
在符合研究标准的 132 例患者中，有 79 例（59.8%）在切除后存在阳性切缘。共有 95 例（72.0%）患者接受了辅助放疗，其中 62 例（78.5%）为 79 例阳性切缘患者。阳性切缘患者的生存率与阴性切缘患者无显著差异（5 年生存率，82.2% [95%CI，71.3-89.3] 与 82.0% [95%CI，67.0-90.6]，P=0.97），即使在多变量调整后也是如此（风险比，1.73；95%CI，0.62-4.84；P=0.30）。在阳性切缘患者亚组中，接受或未接受术后放疗的患者之间的生存无显著差异（5 年生存率，82.0% [95%CI，68.8-89.9] 与 82.4% [95%CI，54.7-93.9]；P=0.80），即使在多变量调整后也是如此（风险比，1.04；95%CI，0.21-5.25；P=0.96）。
在本研究的全国队列中，大多数气管 ACC 切除术的切缘为阳性。辅助放疗常用于阳性切缘，但与总体生存获益无关。
