原发性气管癌患者的临床特征、手术治疗、预后及预后因素：中国国家癌症中心20年数据
Clinical characteristics, surgical treatments, prognosis, and prognostic factors of primary tracheal cancer patients: 20-year data of the National Cancer Center, China.
作者信息
Li Jiagen, Tan Fengwei, Wang Yalong, Xue Qi, Gao Yushun, Mu Juwei, Mao Yousheng, Zhao Jun, Wang Dali, Feng Xiaoli, Shi Susheng, Suda Kenichi, Cardillo Giuseppe, Bertolaccini Luca, Infante Maurizio V, Van Schil Paul E, Gao Shugeng, He Jie
机构信息
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Transl Lung Cancer Res. 2022 May;11(5):735-743. doi: 10.21037/tlcr-22-258.
BACKGROUND
Tracheal cancer is a rare malignancy of which previous reports are mostly case reports or small series. Herein, we sought to evaluate the clinical characteristics, surgical treatments, and prognosis of surgically treated primary tracheal cancer patients.
METHODS
Patients with primary tracheal cancer who had received surgery in our center between January 2000 and December 2020 were enrolled. Clinical and surgical features were collected by retrospective review of medical records and follow-up was done by telephone interview. The statistical tests were two-sided.
RESULTS
A total of 128 patients were included in the study, 49.2% of whom were male, and the average age was 49.4±13.6 years. The most common histological subtype was adenoid cystic carcinoma (ACC; 78/128, 60.9%) followed by squamous cell carcinoma (SCC; 24/128, 18.8%). The percentage of tumors located in the cervical trachea, thoracic trachea, and carina were 50%, 41.4%, and 8.6%, respectively. Among those analyzed, 32.0% of the primary tumors had invaded adjacent organs (E2 disease) and 7.8% of patients had lymph node involvement. Tracheal resection plus reconstruction (with or without thyroidectomy) was the predominant surgical procedure, followed by carinal resection with neocarina. Radical resection (R0) was performed on 61.7% of patients and 63 (49.2%) patients received adjuvant therapy. Compared to ACC, SCC patients had significantly higher risk of tumor of the carina, nodal metastasis, and complications. The 5-year overall survival (OS) for the entire cohort was 84.5% and factors associated with poor prognosis included carinal tumor [hazard ratio (HR) =10.206; P<0.001], E2 disease (HR =8.870; P=0.001), lymph node metastasis (HR =15.197; P<0.001), and postoperative complications (HR =12.497; P=0.001).
CONCLUSIONS
The two major subtypes of tracheal cancer are ACC and SCC. Tumor location, extension, lymph node metastasis and complication are survival related factors for surgically treated patients.
背景
气管癌是一种罕见的恶性肿瘤，以往的报道大多为病例报告或小样本系列研究。在此，我们旨在评估手术治疗的原发性气管癌患者的临床特征、手术治疗方法及预后。
方法
纳入2000年1月至2020年12月期间在本中心接受手术的原发性气管癌患者。通过回顾病历收集临床和手术特征，并通过电话访谈进行随访。统计检验采用双侧检验。
结果
本研究共纳入128例患者，其中男性占49.2%，平均年龄为49.4±13.6岁。最常见的组织学亚型为腺样囊性癌（ACC；78/128，60.9%），其次为鳞状细胞癌（SCC；24/128，18.8%）。位于颈段气管、胸段气管和隆突的肿瘤百分比分别为50%、41.4%和8.6%。在分析的患者中，32.0%的原发性肿瘤侵犯了相邻器官（E2期疾病），7.8%的患者有淋巴结受累。气管切除加重建（伴或不伴甲状腺切除术）是主要的手术方式，其次是隆突切除加新隆突形成术。61.7%的患者进行了根治性切除（R0），63例（49.2%）患者接受了辅助治疗。与ACC相比，SCC患者发生隆突肿瘤、淋巴结转移及并发症的风险显著更高。整个队列的5年总生存率（OS）为84.5%，与预后不良相关的因素包括隆突肿瘤[风险比（HR）=10.206；P<0.001]、E2期疾病（HR =8.870；P=0.001）、淋巴结转移（HR =15.197；P<0.001）和术后并发症（HR =12.497；P=0.001）。
结论
气管癌的两大主要亚型为ACC和SCC。肿瘤位置、侵犯范围、淋巴结转移及并发症是手术治疗患者的生存相关因素。
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