Adenoid Cystic Carcinoma in the Bronchus Behaves More Aggressively Than Its Tracheal Counterpart

Background. 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. Methods. 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. Results. 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). Conclusions. 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. (C) 2013 by The Society of Thoracic Surgeons