Adenoid cystic carcinoma (ACC) of the trachea and bronchus are rare primary bronchopulmonary carcinomas with low malignancy. The prognostic factors ACC are undefined.
217 ACC tumors operated between May 1988 and March 2012 were collected from a cooperative multicenter group in China. We studied clinical and pathological features in these tumors, analyzing prognostic significance and patterns of recurrence. Survival analysis data were collected from a systematic follow-up database. Statistical analyses were carried out using a SPSS V.19.0 statistical package.
Five-year and 10-year survival were excellent, 71% and 51% respectively. Sixty of patients (27.6%) had local recurrence 161 Â± 29 (range 130 to 191) months after surgery. Distance metastases ocurred after a median interval of 87 Â± 56 (range 28 to 146) months after surgery. In a univariable analysis, male (P = 0.02), bronchial AAC (P = 0.002), tubular subtype (P = 0.01), postoperative radiation (P < 0.001) presented statistically significant differences related to survival of these patients. In multivariable analysis, only postoperative radiation was an independent risk factor for survival (P < 0.001; HR: 0.56). Regarding to recurrence factors in a univariable analysis, tubular subtype (P = 0.02) and postoperative radiation (P = 0.008) were associated with locoregional recurrence. Patients with bronchial AAC presented higher frequencies of distant recurrence (P = 0.003). In a multivariable analysis, postoperative radiation was an independent prognostic factor to predict logoregional recurrence (P < 0.001; HR: 0.62).
The long-term outcome was poor due to late local recurrences and late metastatic spread. Complete standard surgical resection is essential for ACC. Conservative excision without postoperative irradiation with advanced lesions are related to logoregional recurrence.
Clinical trial identification
All authors have declared no conflicts of interest.