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目的探讨气管腺样囊性癌(ACC)最佳的合理治疗模式。方法回顾性分析1995年1月至2014年12月上海市胸科医院诊治的原发性气管ACC患者的资料。采用Cox多因素回归分析ACC患者总生存期和无病生存期的影响因素。结果共109例患者纳入分析,其中男性53例(48.6%),女性56例(51.4%);ACC患者的年龄为21~71岁,平均年龄(46.9±9.0)岁,中位年龄46岁;切除的肿瘤平均直径和气管平均长度分别为(28.9±7.4)mm和(32.9±7.4)mm;总体镜下切端阳性(R1)比例为84.4%(92/109)。所有患者的5年和10年总生存率及无病生存率分别为88.7%和43.2%,及62.0%和20.0%。根据切缘阳性与否以及术后是否进行辅助放疗进一步分组分析:在总生存率方面,切缘阴性未进行术后辅助放疗的患者(R0/0)显著优于切缘阳性并进行术后放疗(R1/1)组以及切缘阳性未进行术后放疗(R1/0)组(χ~2=4.410,P=0.036;χ~2=8.448,P=0.004);而R1/1组与R1/0组的总生存率比较差异无统计学意义(χ~2=1.690,P=0.194)。在无病生存率方面,R0/0组和R1/1组均优于R1/0组(χ~2=7.808,P=0.005;χ2=9.907,P=0.002),而R0/0组与R1/1组之间差异无统计学意义(χ~2=2.210,P=0.137)。结论气管ACC外科切除后生存时间较满意;气管ACC浸润范围广,R0切除率低;R1切除的患者辅助放疗能有效改善预后;手术切除或术后联合放疗可作为较局限的该类气管肿瘤的首选治疗方案。
Objective To investigate the optimal treatment of tracheal adenoid cystic carcinoma (ACC). Methods The data of primary tracheal ACC patients diagnosed and treated in Shanghai Chest Hospital from January 1995 to December 2014 were retrospectively analyzed. Cox regression analysis was used to analyze the overall survival and disease-free survival of patients with ACC. Results A total of 109 patients were included in the analysis, including 53 males (48.6%) and 56 females (51.4%). The patients with ACC were 21-71 years old with a mean age of (46.9 ± 9.0) years and a median age of 46 years. The mean tumor removal and mean tracheal length were (28.9 ± 7.4) mm and (32.9 ± 7.4) mm, respectively. The total positive endoscopic resection rate was 84.4% (92/109). The 5-year and 10-year overall and disease-free survival rates for all patients were 88.7% and 43.2%, respectively, and 62.0% and 20.0%, respectively. According to the positive or negative margins and postoperative adjuvant radiotherapy or not, further subgroup analysis showed that in the overall survival rate, patients with negative margins without postoperative adjuvant radiotherapy (R0 / 0) were significantly better than the positive margins and postoperative radiotherapy (R1 / 1) and the positive margins were not treated with radiotherapy (R1 / 0) (χ ~ 2 = 4.410, P = 0.036; There was no significant difference in the overall survival between the two groups (χ ~ 2 = 1.690, P = 0.194). In disease-free survival, R0 / 0 group and R1 / 1 group were superior to R1 / 0 group (χ ~ 2 = 7.808, P = 0.005; χ2 = 9.907, P = 0.002) / 1 group, the difference was not statistically significant (χ ~ 2 = 2.210, P = 0.137). CONCLUSIONS: Survival time after ACC resection of trachea is satisfactory, and the range of ACC infiltration in trachea is wide and R0 resection rate is low. Adjuvant radiotherapy in patients with resected R1 can effectively improve the prognosis. Surgical resection or postoperative combined radiotherapy can be used as a more limited type of tracheal tumor Preferred treatment options.