Prognostic value of pathologic characteristics and resection margins in tracheal adenoid cystic carcinoma
ABSTRACT We investigate the influence of tumour and resection characteristics on survival in adenoid cystic carcinoma (ACC) of the trachea.
A retrospective study of 12 laryngotracheal, 58 tracheal and 38 carinal resections for primary ACC in 108 consecutive operative survivors between 1962 and 2007 was conducted. Postoperative radiotherapy was administered to 82% of patients (89/108). Depth of invasion, extramural extent, organ invasion, perineural growth, margin status and lymph node involvement were described.
The tumour was intramural in 15% (16/108), extramural in 85% (92/108) and invaded adjacent organs in 20% (22/108). Airway margins were grossly positive in 9 (8%), microscopically positive in 59 (55%) and negative in 40 (37%) of 108 resections. Adventitial (radial) margins of transmural sections were grossly positive in 3 (3%), microscopically positive in 95 (88%) and negative in 10 (9%) cases. Perineural growth was present in 37 (34%) and absent in 12 (11%); it was not observed in 59 (55%) cases. Lymph nodes were positive in 16 (15%) and negative in 45 (42%) cases; it was not sampled in 47 (44%) cases. Median overall survival (OS) and disease-free survival (DFS) for the entire group were 17.7 and 10.2 years, respectively. OS was longer after resection with: negative airway margins (20.4 vs 13.3 years, P=0.028) and negative radial margins (21.7 vs 13.3 years, P=0.050); absence of extramural disease (21.7 vs 13.3 years, P=0.007), perineural growth (22.8 vs 7.5 years, P=0.011) or lymph node metastases (16.8 vs 6.1 years, P=0.017). DFS was longer after resection with: negative airway margins (16.6 vs 9.3, P=0.005) and absence of extramural disease (17.9 vs 9.3 years, P=0.008), perineural growth (17.9 vs 6.6 years, P=0.033) or lymph node metastases (10.2 vs 3.0 years, P=0.005).
After tracheal resection for ACC, limited tumour extent and complete resection are associated with longer overall and disease-free survival. Long-term survival (>10 years), however, is also observed after tracheal resection of locally advanced ACC.
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ABSTRACT: Primitive tumors of the trachea are rare, accounting for 0.1% of the airway tumors. Cystic adenoid carcinoma (or cylindroma) represents the second most frequent type of tracheal cancers. Histologically speaking, this tumor type is divided in three patterns: cribriform, tubular and solid; it presents a slow growth, perineural invasion and potential local recurrence and metastasis. We presented herein the case of a 56-year-old female suffering from a cystic adenoid carcinoma of the low trachea. She has been treated by carinal resection with negative airway margin and complete reconstruction, with the help of an extra corporeal membrane oxygenation (ECMO).Revue de Pneumologie Clinique 04/2013; DOI:10.1016/j.pneumo.2013.02.002 · 0.19 Impact Factor
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ABSTRACT: 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.The Annals of thoracic surgery 10/2013; 96(6). DOI:10.1016/j.athoracsur.2013.08.009 · 3.65 Impact Factor
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ABSTRACT: To perform a national review of the incidence and treatment of primary tracheal cancer and to identify gaps in service provision and factors associated with survival. Retrospective analysis of Hospital Episode Statistics data for England between 1996 and 2011. Information about age, sex, morbidity, provider trust, diagnostic delay, nature of hospital admission and treatment, and palliation-free survival were recorded. The relationship between variables and survival was explored with Cox regression. There were 874 patients, giving an incidence of 0.9 per million. Mean age at diagnosis was 66 ± 13, and there were 456 (52%) males. Mean presentation to diagnosis latency was 2.5 ± 8 months, and 40% of patients presented as emergency admissions. There were 19 cases of oesophageal involvement and 241 cases of bronchopulmonary involvement; and 188 patients developed distant metastases. There were 60 curative resections (6.9%), which was the most significant predictor of palliation-free survival (hazard ratio: 0.23; 95% confidence interval 0.13-0.38). Other prognostic variables included age, sex, emergency admission, interventional bronchoscopy, chemotherapy, oesophageal involvement, and distant metastases. Ten-year palliation-free survival was 60.8% with curative resection and 19.5% overall. Eighty-six percent of patients were treated in units that treated fewer than one patient per year. Tracheal cancer is under-recognized and under-treated. Early diagnosis, access to interventional bronchoscopy, and surgical treatment in specialist units may improve the survival of patients with this condition. 4. Laryngoscope, 2013.The Laryngoscope 01/2014; 124(1). DOI:10.1002/lary.24123 · 2.03 Impact Factor