Predictors of nodal metastasis and prognostic significance of lymph node ratio and total lymph node count in tracheobronchial adenoid cystic carcinoma

Primary malignant tumors of the trachea: a retrospective analysis of the clinical data of 79 patients treated in a single center

Background

Primary malignant tumors of the trachea are rare. There are few data on such tumors, the understanding of the disease is limited, and the best treatment plan has not yet been determined.

Methods

Clinical data obtained from the medical records of 79 patients with primary malignant tumors of the trachea treated in our hospital between August 2008 and August 2023 were retrospectively analyzed. The clinical data included demographic characteristics (age, sex), carcinogen exposure (smoking or drinking), symptoms, histology, primary tumor location (cervical trachea, intrathoracic trachea or bronchus), primary tumor range, lymph node status, and treatment. SPSS 26.0 software was used for statistical analysis. The Kaplan- Meier method was used to calculate the survival rate, and the log-rank test was used to compare the survival differences between groups. Multivariate analysis was performed using the Cox regression model.

Results

Patients with primary tracheal ACC were significantly younger than those with SCC were (45.5 years old vs. 66.0 years old, P = 0.000007). SCC is more common in smoking and male patients, whereas ACC and other pathological types are more common in nonsmoking and female patients. ACC patients were less likely to have lymph node metastasis than SCC patients were (12.5% vs. 36%, P = 0.047). The 3-year, 5-year and 10year overall survival rates were 69.9%,62.3% and 34.2%, respectively, and the median OS was 96 months. The 3-year overall survival rates of patients with ACC, SCC, and other pathological types were 86.3%, 47.1%, and 71.4%, respectively. The 5-year overall survival rates were 77.0%, 26.5% and 62.5%, respectively. The 10-year overall survival rates were 39.5%, 13.3% and 62.5%, respectively. The overall survival of SCC patients was the shortest among all pathological types, and the difference was statistically significant. The COX regression analysis further demonstrated that a higher N stage is significantly associated with an elevated risk of distant metastasis.

Conclusion

Primary malignant tumors of the trachea are rare, and the best treatment has not yet been determined. Although most patients in this center are treated via a variety of methods, whether this varied approach to treatment is the reason for the higher overall survival cannot be ascertained. Moreover, most patients in our center received a variety of treatments, so a survival analysis of specific treatment modalities was not possible. Thus, more studies involving more patients are needed to ascertain the optimal treatment plan for malignant tracheal tumors.

Clinical Characteristics, Treatment and Prognosis of Primary Tracheal Adenoid Cystic Carcinoma: A Multicenter Retrospective Study

BACKGROUND

Tracheal adenoid cystic carcinoma (TACC) is a rare salivary gland malignant tumor. Previous studies mainly focused on surgery, radiation, and chemotherapy. The purpose of this study is to describe more clinical characteristics, treatments, and overall survival (OS) of TACC.

METHODS

Retrospectively analyzed TACC patients from two medical institutions and the SEER database from January 2010 to December 2021. Survival curves were drawn using the Kaplan-Meier method, and the effects of prognosis were analyzed by multivariate COX regression and AFT. The endpoint of the study was overall survival (OS).

RESULTS

One hundred fifty TACC patients were enrolled (DZM 11, EG 64, SEER 75), and the 5- and 10-year survival rate was 70.62% and 35.80%, with a median survival time of 98 months. Lymph node status (yes) is an independent risk factor for TACC (HR = 3.020, 95% CI = 1.419-6.426, p = 0.004), and surgery is an independent protective factor (HR = 0.293, 95% CI = 0.146-0.587, p = 0.001). The AFT yielded similar results. In subgroup analysis of 63 non-surgical patients, lymph node status (Yes) (HR = 3.511, 95% CI = 1.498-8.229, p = 0.004), and tumor longitudinal diameter range (TLDR) > 1 (HR = 2.975, 95% CI = 1.360-6.506, p = 0.006) are independent risk factors, while Targeted Therapy (HR = 0.248, 95% CI = 0.096-0.637, p = 0.004) is an independent protective factor.

CONCLUSION

Lymph node status and TLDR are prognostic factors of TACC. Surgery is associated with prolonged survival of TACC. Targeted therapy may be associated with improved survival among non-surgical TACC patients.

TRIAL REGISTRATION

ChiCTR2400083551.

Prognosis of palliative treatment for primary tracheal carcinoma: a two-center retrospective study

Introduction

More than half of patients with tracheal carcinoma (TC) do not receive radical treatment, but the clinical characteristics, palliative treatment options, and prognosis of this group remain unclear.

Methods

This retrospective study analyzed 94 single primary TC patients (42 with tracheal squamous cell carcinoma [TSCC] and 52 with tracheal adenoid cystic carcinoma [TACC]) admitted to the Emergency General Hospital and Dongzhimen Hospital, Beijing University of Chinese Medicine. Kaplan-Meier survival curves, Log-rank tests, univariate and multivariate Cox and AFT models were used to assess overall survival (OS).

Results

Among 89 patients without radical treatment, the median survival was 57 months, with 5-year and 10-year survival rates of 46.33% and 13.43%, respectively. Univariate analysis identified pathological type, smoking history, initial tumor extension (ITE), and targeted therapy as significant prognostic factors. The AFT model revealed that the median OS for TSCC patients was significantly shorter than for TACC patients, with a time ratio (TR) of 0.243 (95% CI: 0.153-0.386; P < 0.01), while targeted therapy was associated with a 1.790-fold increase in OS (TR: 1.790, 95% CI: 1.061-3.020; P = 0.029). Patients with extensive ITE had worse outcomes, with a TR of 0.628 (95% CI: 0.406-0.971; P = 0.037). Smokers had a TR of 0.601 (95% CI: 0.397-0.912; P = 0.017) compared with non-smokers. Subgroup analysis showed that smoking history was strongly associated with shorter OS in TSCC but not in TACC.

Conclusions

Pathological type, ITE, targeted therapy and smoking history are important factors for evaluating the prognosis of TC patients receiving palliative treatment.

Primary tracheo-bronchial adenoid cystic carcinoma: A surgical series with literature review

Tracheo-bronchial adenoid cystic carcinoma (TBACC) is a rare disease. Its treatment is mainly surgical. We herein describe the clinical and para-clinical varieties of TBACC as well as their surgical treatment and prognosis. We conducted a retrospective study of eight patients operated on between 1994 and 2022 and whose definitive pathological examination concluded with primary TBACC. There were three men and five women with an average age of 44 years. The bronchoscopy found a budding formation reducing the tracheal lumen at the cervical (two cases), middle (two case) and distal trachea and carina (four cases). Bronchial anastomosis resection and sleeve pneumonectomy were the most common procedures. Surgical resections R0 were achieved in five patients. Surgery followed by adjuvant radiotherapy was performed in two patients with incomplete surgical resection R1. The overall survival for all patients with primary ACC was 72% at 5 years. TBACC is a rare and low-to-moderate grade malignant tumour. The choice of the surgical procedure and the appropriate approach is challenging to obtain a promising prognosis.

[Tracheal Tumours]

Malignant primary tracheal tumours are rare. The most common histological subtypes are squamous cell carcinoma and adenoid cystic carcinoma. These two entities have different prognoses and growth patterns. Tracheobronchoscopy and thoracic sectional imaging are standard diagnostic tools for tumour staging and local evaluation. Complete surgical resection of the affected tracheal segment is the treatment of choice for limited disease without distant metastases. Incomplete gross tumour resection with additional irradiation is an acceptable therapeutic option for adenoid cystic carcinoma. Interventional endoscopy with tumour debulking or tracheal stenting and/or definitive mediastinal radiotherapy are treatment alternatives in either a locally advanced or palliative setting.

A population study comparing tracheal and lung adenoid cystic carcinoma

BACKGROUND

Thoracic adenoid cystic carcinoma (ACC) is rare, and the differences between tracheal and lung lesions have not been fully understood.

METHODS

Patients were identified from a Chinese cancer center (FUSCC) (2005-2022) and the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019). Incidence was calculated and trends were quantified. Clinicopathological features and overall survival (OS) were analyzed. Nomograms predicting OS were constructed.

RESULTS

Totally, 55 tracheal adenoid cystic carcinoma (TACC) and 25 lung and bronchus adenoid cystic carcinoma (LACC) were included in a Chinese cohort, 121 TACC and 162 LACC included in the SEER cohort. There were larger tumor sizes, more lymph nodes and distant metastases for LACC than TACC patients. TACC patients are more likely to get local treatments. Patients with LACC had significantly worse median OS than patients with TACC (SEER cohort: 68.0 months vs. 109.0 months, p = 0.001, Chinese cohort: 62.9 months vs. 124.8 months, p = 0.061). Age, lymph node metastasis, distant metastasis and local treatment were identified as independent prognostic factors for OS of TACC. Distant metastasis and local treatment were identified for LACC. Specifically, surgery alone or in combination with radiotherapy is crucial for improving survival in both TACC and LACC. Only TACC benefits from radiotherapy alone, while chemotherapy does not improve survival for either. The nomograms constructed using these factors revealed good prognostic accuracy.

CONCLUSIONS

LACC is more aggressive and has a worse prognosis than TACC. TACC patients have more opportunities for local treatment, which is important for the prognosis of both TACC and LACC. Nomograms were created for TACC and LACC to aid in personalized survival predictions and clinical decisions.

Primary pulmonary adenoid cystic carcinoma: A clinicopathological study of 64 patients

BACKGROUND

This study aimed to investigate the clinicopathological features and prognostic indicators of primary pulmonary adenoid cystic carcinoma (PACC).

METHODS

Clinical data were collected from 64 primary PACC patients and analyzed retrospectively at the Tianjin Medical University General Hospital, the West China Hospital of Sichuan University, the First Affiliated Hospital of Guangxi Medical University, and the Bishan Hospital of Chongqing Medical University from January 2003 to August 2023. The 64 patients (28 males and 36 females) were aged from 20 to 73 years, with a median age of 49 years and an average age of 49.3 years.

RESULTS

Immunohistochemical staining showed that the tumors expressed CK7, S-100 protein, CK5/6, CD117, and p63. Seven patients underwent fluorescence in situ hybridization (FISH) testing and three were found to have myeloblastosis (MYB) gene translocation. In total, 53 patients underwent surgery, among whom 31 received only surgery and 22 received both surgery and postoperative chemoradiotherapy. In addition, 10 patients received chemoradiotherapy only, while one patient underwent treatment with traditional Chinese medicine. The overall survival rates in the first, third, and fifth years were 98.4%, 95.3%, and 87.5%, respectively.

CONCLUSION

Prognostic analysis revealed that age, tumor size, lymph node metastasis status, margin status, and choice of treatment modality significantly influenced the patients' prognosis.

The impact of surgery and age on mortality with primary trachea malignant tumors: a retrospective study based on propensity-score matching analysis

PURPOSE

This study aimed to explore the survival significance of surgery and age on the prognosis of patients with primary trachea malignancies.

METHODS

The entire cohort of 637 patients with primary malignant trachea tumors was used to perform the main analyses. The data of those patients were from a public database. Overall survival (OS) curves were drawn by the Kaplan-Meier method and compared by the Log-rank test. The univariable and multivariable Cox regression analyses calculated the hazard ratio (HR) and 95% confidence interval (CI) for overall mortality. The propensity-score matching analysis was used to reduce the selection bias.

RESULTS

Age, surgery, histological type, N classification, M classification, marital status, and tumor grading were identified as independent prognostic factors after eliminating confounding factors. The results of the Kaplan-Meier method revealed that patients with age < 65 had a survival advantage over those with age ≥ 65 (HR = 1.908, 95% CI 1.549-2.348, P < 0.001). The 5-year OS rates were 28% and 8% in the group with age < 65 and age ≥ 65, respectively (P < 0.001). Cases with surgery had better survival over patients without surgery (HR = 0.372, 95% CI 0.265-0.522, P < 0.001). Compared with patients who did not undergo operations, patients with surgery had a higher median survival time (20 vs. 174 months). For patients with surgery, young age was considered a survival-promoting factor (HR 2.484; 95% CI 1.238-4.983, P = 0.010).

CONCLUSION

We suggested that age and surgery were the independent prognostic factors in patients with primary malignant trachea tumors. Besides, age serves as an essential indicator for evaluating the prognosis of postoperative patients.

Primary pulmonary adenoid cystic carcinoma- clinicopathological features and predictors of poor outcome

Introduction

Primary pulmonary adenoid cystic carcinoma is a rare disease. Its clinico-pathological features, course of disease, therapeutic strategy, and survival data have not been fully elucidated. We aimed to study the clinicopathological characteristics of primary pulmonary adenoid cystic carcinomas in north India.

Methods

This study was a retrospective, single-centre, cohort study. The database of the hospital was searched for a period of seven years to identify all patients with primary pulmonary adenoid cystic carcinoma.

Results

Out of 6050 lung tumors, 10 were primary adenoid cystic carcinomas. The mean age of diagnosis was 42 (±12) years. Six patients had the lesion in the trachea, main bronchus or truncus intermedius and four had parenchymal lesions. Seven patients had resectable tumours. Three patients achieved an R0 resection, two achieved R1 resection and two had R2 resection. On histopathological examination, almost all of the patients had cribriform pattern. Only four patients (57.1%) showed positivity for TTF-1 staining. The five-year survival of patients with resectable tumour and un-resectable tumour was 85.7% and 33.3%, respectively (P = 0.01). The predictors of poor outcome included non-operability of the tumour, presence of metastasis at the time of diagnosis, and macroscopically positive tumour margin during surgery.

Conclusion

Primary pulmonary adenoid cystic carcinoma is a unique and rare tumour that affects relatively younger individuals, males and females, as well as smokers and non-smokers equally. The features of bronchial obstruction are the most common. Surgery is the primary modality of treatment and completely resectable lesions have the best prognosis.

Number of positive lymph nodes affects outcomes in parotid adenoid cystic carcinoma

Objectives

Survival significance of the number of positive lymph nodes (LNs) in parotid adenoid cystic carcinoma (ACC) remains unknown; thus, this study aimed to determine the impact of the number of positive LNs on the prognosis of parotid ACC.

Methods

Patients with surgically treated parotid ACC were enrolled from the SEER database. The number of positive LNs was analyzed using three models (0 vs 1+, 0 vs 1 vs 2 vs 3 vs 4 vs 4 vs 5 vs 6+, 0/1 vs 2-4 vs 5+), its hazard ratios on disease specific survival (DSS) and overall survival (OS) were assessed using univariate and multivariate Cox analyses.

Results

A total of 1,689 patients were included. In all models, the number of positive LNs was independently related to DSS and OS, model 3 had the highest C-index for DSS [0.83 (95% CI: 0.81-0.85)] and OS [0.82 (95% CI: 0.80-0.84)]. Compared with the 0/1 positive LN group, the 2-4 positive LN group had an HR of 2.81 (95% CI: 1.73-4.56) for DSS and 2.36 (95% CI: 1.58-3.54) for OS. The 5+ LN group had an HR of 20.15 (95% CI: 7.50-54.18) for DSS and 14.20 (95% CI: 5.45-36.97) for OS. No overlap existed in the 95% CI of the HR.

Conclusions

The three prognostic categories based on the number of positive LNs (0/1 vs 2-4 vs 5+) could stratify the DSS and OS in parotid ACC without overlap.

Assessing Whether Morphological Changes in Axillary Lymph Node Have Already Occurred Prior to Metastasis in Breast Cancer Patients by Ultrasound

Background and Objectives: Whether the morphological changes in axillary lymph node (ALN) have occurred prior to metastasis remains unclear in breast cancer (BC) patients. The aim of this study is to investigate the influence of BC for the morphology of non-metastasis ALN (N−) and, further, to improve the performance of ultrasound (US) examination for metastasis ALN (N+). Materials and Methods: In this retrospective study, 653 patients with breast mass were enrolled and divided into normal group of 202 patients with benign breast tumor, N− group of 233 BC patients with negative ALN and N+ group of 218 BC patients with positive ALN. US features of ALN were evaluated and analyzed according to long (L) and short (S) diameter, the (L/S) axis ratio, cortical thickness, lymph node edge, replaced hilum and color Doppler flow imaging (CDFI). Results: ALN US features of short diameter, replaced hilum, cortical thickness and CDFI have significant statistical differences in N− group comparing with normal group and N+ group, respectively (p < 0.05). Conclusions: Therefore, BC can affect ALN and lead to US morphological changes whether lymph node metastasis is present, which reduces the sensitivity of axillary US. The combination of US and other examination methods should be applied to improve the diagnostic performance of N+.

Occult neck metastases risk factors and the role of elective neck dissection in cT3-4N0 adenoid cystic carcinoma of the parotid gland

Objectives

To determine the predictor for occult neck metastases and the role of elective neck dissection (END) in cT3-4N0 parotid adenoid cystic carcinoma (ACC).

Methods

Patients with surgically treated parotid ACC were retrospectively enrolled. Predictors of occult neck metastases and the effect of END on disease specific survival (DSS), overall survival (OS), locoregional control survival (LRC), and distant metastasis free survival (DMS) were analyzed.

Results

Occult neck metastases occurred in 35 (19.7%) of the 178 patients undergoing an END. The tumor stage [p=0.011, 4.215 (1.387–10.435)] and intra-parotid lymph node metastasis [p=0.032, 3.671 (1.693–8.775)] were related to the possibility of occult neck metastases independently. The END group had better 10-year LRC than the observation group (56% vs. 43%, p=0.002) and also better 10-year DMS than the observation group (43% vs. 32%, p<0.001). The two groups had similar 10-year DSS (40% vs. 33%, p=0.230) and OS (31% vs. 23%, p=0.094) rates. Furthermore, the Cox model confirmed that END was independently associated with better LRC rate [p=0.022, 2.576 (1.338–6.476)] and better DMS [p=0.011, 2.343 (1.274–7.462)].

Conclusions

Occult neck metastases in cT3-4N0 parotid ACC was not common. A T4 tumor with intra-parotid lymph node metastasis had the highest possibility of occult neck metastases. END had no effect on DSS or OS but significantly decreased the risk of locoregional recurrence and distant metastasis.

Adenoid Cystic Carcinoma of Lobar Bronchial Origin: 20-Year Experience at a Single Institution

BACKGROUND

Pulmonary adenoid cystic carcinoma (ACC) is a rare type of lung malignancy. The prevalence of ACC of lobar bronchial origin is lower than that of other lung malignancies, and studies investigating it are lacking. This study aimed to evaluate survival of patients with ACC of the lobar bronchus after surgical resection and to explore its prognostic factors.

METHODS

Between January 2000 and December 2019, 35 patients at the National Cancer Center/Cancer Hospital with a diagnosis of ACC of the lobar bronchus were included in the retrospective analysis.

RESULTS

During a median follow-up period of 61 months (range, 10-194 months), the analysis showed a 5-year overall survival (OS) rate of 81.4%, a 5-year locoregional recurrence-free survival rate of 84.0%, and 5-year disease-free survival rate of 60.1%. The univariate analysis exclusively identified the surgical margin as a predictor of OS, and survival was significantly longer for the patients with negative surgical margins than for those with positive surgical margins (R0 vs. R1: 94.4% vs. 66.0%; p = 0.014). Adjuvant radiotherapy was administered to most of the patients with positive surgical margins, which might have contributed to prolonged OS (R0 vs. R1+RT: 94.4% vs. 66.7%, p = 0.173; R0 vs. R1+no RT: 94.4% vs. 62.5%, p = 0.007).

CONCLUSIONS

For ACC of lobar bronchial origin, complete resection is the radical treatment, and the OS rate was significantly higher for the R0 patients than for the R1 patients. Adjuvant radiotherapy for patients with R1 may prolong survival.

Do We Need TNM for Tracheal Cancers? Analysis of a Large Retrospective Series of Tracheal Tumors

Simple Summary

The TNM (tumor, node, metastases) staging system established by the Union for International Cancer Control/American Joint Committee on Cancer is commonly used to select a treatment method for patients with cancers, guide adjuvant therapy after surgery, and predict the prognosis. It is an essential tool for working with cancer patients in everyday medical practice. Currently, the eighth edition of the TNM staging system is used. Primary tracheal tumors are uncommon neoplasms. Probably due to their rarity, neither an AJCC staging system nor other, widely accepted staging system exists for primary tracheal cancers. Only a few studies stated their proposed guidelines for the staging of tracheal neoplasms. The absence of a universally adopted staging system makes it difficult for clinicians to assess tracheal cancers properly. This makes it challenging to conduct analyses and compare the results of published works. A standard classification system would help assess and qualify patients for treatment and, perhaps, establish uniform indications for adjuvant treatment. All this could contribute to an increase in the proportion of patients qualified for radical surgery, which is the preferred treatment method.

Abstract

Due to the low incidence of primary tracheal neoplasms, there is no uniform system for staging of this disease. Our retrospective analysis based on registry data included 89 patients diagnosed with primary tracheal cancer at the National Research Institute of Oncology in Warsaw, Poland, between January 2000 and December 2016. We analyzed demographic, clinical, pathological, therapeutic, and survival data. The staging—for the purpose of our analysis—was performed retrospectively on the basis of imaging results. Tumor (T) category was defined as a disease confined to the trachea or lesion derived from the trachea and spreading to adjacent structures and organs. Node (N) and metastases (M) categories were divided into absence/presence of metastasis in regional lymph nodes and the absence/presence of distant metastasis. Survival analysis was performed depending on the clinical presentation of these features. There was a significant difference in overall survival depending on the T, N, M categories in the entire group. In the group of patients undergoing radical treatment, the T and N categories had a statistically significant impact on overall survival. In the group of patients treated with palliative aim, only the T category had an impact on overall survival. Multivariate analysis showed statistical significance for the T category in patients undergoing radical and those receiving palliative treatment. The assessment of the anatomical extent of lesions may help decide about treatment options and prognosis.

Intensity modulated radiation therapy may improve survival for tracheal-bronchial adenoid cystic carcinoma: A retrospective study of 133 cases

PURPOSES

This study aimed to evaluate the role of radiotherapy (RT) and intensity modulated radiation therapy (IMRT) in adjuvant and definitive settings of tracheal-bronchial adenoid cystic carcinoma (TACC) treatment.

MATERIALS/METHODS

TACC patients (n = 133) treated with surgery and/or RT curatively in our institution between January 1^st, 1984 and December 31^st, 2017 were analyzed retrospectively.

RESULTS

Among the 116 patients undergoing surgery, 50 (43.1 %) achieved complete resections and 66 (56.9 %) had positive surgical margins. For patients with positive margins, overall adjuvant RT was correlated with no significantly improved OS (10-year: 58.0 % vs. 47.9 %; P =  0.340) and a slight LRFS benefit (5-year: 81.9 % vs.75.6 %; P =  0.056), but adjuvant IMRT showed significant superiority in both OS (10-year: 82.9 % vs. 47.9 %; P =  0.031) and LRFS (5-year: 100.0 % vs. 75.6 %; P =  0.001) in comparison with no postoperative RT. Multivariate analysis also identified adjuvant IMRT as a significant favorable factor with OS (HR = 0.186, 95 %CI: 0.039-0.883; P =  0.034). For 17 patients receiving definitive RT, IMRT achieved promising 5-year OS of 88.9 % and LRFS of 64.3 %, yet no significant difference from non-IMRT group was reached (P = 0.447 and 0.706). Different therapies presented no significantly different impact on DMFS, whilst DMFS explained more of the OS variances (P < 0.001, R² = 0.480) than LRFS (P < 0.001, R² = 0.323).

CONCLUSION

IMRT could confer greatly improved OS and LRFS in postoperative setting for TACC patients with positive surgical margins. IMRT was also a good therapeutic option for definitive TACC with promising survival and local control.

Patterns of Care and Outcomes of Primary Adenoid Cystic Carcinoma of the Trachea

OBJECTIVE

Primary tracheal malignancies are relatively rare cancers, representing 0.1% to 0.4% of all malignancies. Adenoid cystic carcinoma (ACC) is the second most common histology of primary tracheal malignancy, after squamous cell carcinoma. This study aims to analyze demographic characteristics and potential influencing factors on survival of tracheal ACC (TACC).

METHODS

This was a retrospective cohort study utilizing the National Cancer Database (NCDB). The NCDB was queried for all cases of TACC diagnosed from 2004 to 2016 (n = 394). Kaplan-Meier (KM) and Cox proportional-hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes.

RESULTS

Median age of diagnosis was 56 (IQR: 44.75-66.00). Females were affected slightly more than males (53.8% vs 46.2%). The most prevalent tumor diameter range was 20 to 39 mm (34.8%) followed by greater than 40 mm in diameter (17.8%). Median overall survival (OS) was 9.72 years with a 5- and 10-year OS of 70% and 47.5%, respectively. Localized disease was not associated with a survival benefit over invasive disease (P = .388). The most common intervention was surgery combined with radiation therapy (RT) at 46.2%, followed by surgery alone (16.8%), and standalone RT (8.9%). When adjusting for confounders, surgical resection was independently associated with improved OS (HR 0.461, 95% CI 0.225-0.946). Tumor size greater than 40 mm was independently associated with worse OS (HR 2.808; 95% CI 1.096-7.194).

CONCLUSION

Our data suggests that surgical resection, possibly in conjunction with radiation therapy, is associated with improved survival, and tumor larger than 40 mm are associated with worse survival.

Clinical features, treatment and outcomes in patients with tracheal adenoid cystic carcinoma: a systematic literature review

Background

Primary tracheal adenoid cystic carcinoma (TACC) is rare and originates from the minor salivary gland. Biologically, TACC results in delayed presentation, and the therapeutic effects of multimodal treatment differ across individuals. This study aimed to review cases of TACC to identify clinical features, imaging modalities, treatment, and patient outcomes across follow-ups.

Methods

The PubMed, Web of Science and MEDLINE databases were searched to identify articles reporting cases of TACC. The study variables included in the analysis were patient demographics, biological characteristics, presenting symptoms, imaging modalities, treatments, follow-up times and survival outcomes.

Results

A total of 76 articles and 1252 cases were included in this review. The most common presenting symptom was dyspnoea (86.0%), followed by cough (58.0%). Surgery alone (40.9%), surgery with postoperative radiotherapy (36.4%) and radiotherapy alone (19.2%) were used most frequently treatments modalities. Of the 1129 cases with disease control and survival data, there was no evidence of disease in 78.7%, local recurrence was reported in 3.8%. Distant metastasis rate was 24.9% of 418 reported cases, lung (44.2%) was the most commonly involved organ. The 5, 10 years survival rate of patients treated with surgery alone and surgery with postoperative radiotherapy were 86.4%, 55.6% and 97.3%, 44.4%, respectively.

Conclusion

TACC most common presenting symptoms were dyspnoea, cough and shortness of breath. Surgery alone and surgery with postoperative radiotherapy are predominant treatment modalities. Both seems to provide a good result in term of disease control and long-term survival rate in patients with TACC.

Are left ventricular muscle area and radiation attenuation associated with overall survival in advanced pancreatic cancer patients treated with chemotherapy?

AIM

To evaluate whether cardiac muscle area and radiation attenuation, determined using pre-chemotherapy computed tomography (CT), are associated with therapeutic response and overall survival (OS) in chemotherapy-treated advanced pancreatic cancer (APC) patients.

MATERIALS AND METHODS

Ninety-eight chemotherapy-treated APC patients who underwent pre-chemotherapy CT between 2009 and 2018 were considered. Left ventricular muscle area (LVMA) and left ventricular muscle radiation attenuation (LVMRA) were measured using pre-chemotherapy arterial-phase CT. OS and progression-free survival (PFS) were analysed using Kaplan-Meier curves. Univariate and multivariate Cox regression analyses were performed to analyse potential factors affecting OS and PFS.

RESULTS

Patients with low LVMRA, low LVMA at baseline CT, and multiple metastases had a significantly shorter median OS than patients with high LVMRA, high LVMA, and without multiple metastases (8.8 versus 14 months, p=0.017; 12.2 versus 18.1 months, p=0.038; 7.3 versus 13.5 months, p<0.001, respectively). Patients with low LVMRA and distant metastasis had a shorter median PFS than patients with high LVMRA and those without distant metastasis (4.9 versus 8.3 months, p=0.032; 5.4 versus 9.9 months, p=0.002, respectively). Moreover, the mean LVMRA was the highest in the partial response group (p=0.028).

CONCLUSION

LVMRA could well predict PFS and OS in chemotherapy-treated APC patients.