Tracheobronchial Adenoid Cystic Carcinoma: 50-Year Experience at the National Cancer Center, China

Background. Only a small series of studies has investigated primary tracheobronchial adenoid cystic carcinoma (TACC), and its prognosis and prognostic factors have not been well defined. Methods. Patients with TACC diagnosed histologically between January 1967 and December 2017 at our institution were retrospectively analyzed. Results. A total of 191 consecutive patients were included in our study. One hundred sixty-three patients underwent surgery, while the remaining 28 patients received nonoperative therapy. The 5-year, 10-year, and 20-year survival rates of the surgical group were 85.00%, 63.40%, and 47.00%, while the 5-year and 10-year survival rates of the nonoperative group were 63.70% and 46.40%, respectively. The multivariate analysis showed that the complaint duration (<7 months or >= 7 months) and treat- ment methods (RO resection, R1 resection with radiotherapy, R1 resection without radiotherapy) were independent prognostic factors for disease-free survival of the R0/1 (resection with no residual tumor or microscopic residual tumor) resected patients, while the tumor size (<= 3 cm or >3 cm) and treatment methods were independent prognostic factors for the overall survival. Sixty-four (45.1%) patients in the R0/1 group experienced recurrence/progression, and compared with chemotherapy or supportive treatment, local treatment significantly improved the prognosis of these patients (P < .050). Conclusions. The complaint duration and tumor size are independent prognostic factors for disease-free survival and overall survival in TACC, respectively. Complete resection of the primary tumor, postoperative adjuvant radiotherapy for patients with positive margins, and local treatment after postoperative recurrence or progression may contribute to better survival. (C) 2019 by The Society of Thoracic Surgeons