A SEER database cohort of 868 patients with primary tracheal cancers: characteristics and outcomes and the role of bronchoscopic interventions

Abstract

Introduction: Primary tracheal cancers have a yearly prevalence of 2.6 cases per million people. Because of their rarity there is a lack of studies investigating them. In this study, we investigate the clinical characteristics and outcomes of primary tracheal cancers using a large population database. Methods: The Surveillance, Epidemiology and End Results (SEER) database was queried between 1973 and 2016 to identify a retrospective cohort of patients with primary tracheal cancers. Demographic information, tumor characteristics, treatments administered, and survival in months were investigated. Results: Eight hundred sixty-eight cases were analyzed. The majority of the patients were male (56.8%) with an average age of 62.13 ( ± 15.67). Squamous cell carcinoma (SCC) was the predominant subtype (42.9%) followed by adenoid cystic carcinoma (ACC) (18.1%). Five-year survival was 21.6% and median survival was 12 months. Patients with ACC had more localized tumors, received surgery more often and had longer survival than patients with SCC (P < 0.01). Both groups had best outcomes when treated with surgery. Bronchoscopic intervention was associated with favorable outcomes for ACC. For SCCs, bronchoscopic interventions followed by adjuvant therapy had better outcomes than radiotherapy alone. Cox proportional hazards identified advanced age and stage, radiotherapy and chemotherapy as negative predictors of outcome. Whereas ACC and sarcoma histology and diagnosis between 2010 and 2016 were positive prognosticators. Conclusions: Tracheal cancers have poor outcomes with a median survival of 12 months and 5-year survival of only 21.6%. Surgical resection should be the treatment of choice wherever feasible. In patients with ACCs who are not surgical candidates bronchoscopic interventions may provide appropriate treatment and palliation and improved survival. For SCCs, bronchoscopic intervention wherever possible with adjuvant therapy may be favorable to radiotherapy alone.

Advances in tracheal reconstruction and tissue engineering

“…Postintubation injury is the most common cause of tracheal stenosis, with an estimated incidence of 4.9 cases per million per year [2] , and in some reports, an incidence as high as 19% and 65% in tracheal intubation and tracheostomy patients, respectively [3,4] . While short segments (< 2 cm) of postintubation stenosis can be treated with conservative techniques, including endoluminal ablation and dilation, in the United States, about 4000 cases per year of postintubation stenosis are treated by resection and reconstruction [5][6][7] . Comparatively rarer causes of tracheal stenosis are acute trauma or cancer; however, these causes often necessitate a surgical approach for definitive treatment.…”

“…These include laryngeal, suprahyoid, hilar, and pericardial release maneuvers [12,13] . Extensive mobilization by circumferential dissection risks devascularization of the anastomosis, anastomotic dehiscence, or restenosis and should be avoided [7] . For the patient with recurrent stenosis after primary reconstruction, slide tracheoplasty represents a possible treatment option.…”