Demography, patterns of care and survival outcomes in patients with malignant tumors of trachea: A systematic review and individual patient data analysis of 733 patients

Dear Editor, Primary malignant tumors of the trachea account for 0.01%-0.4% of all cancer cases [1]. Due to their locally aggressive growth, surgical resection including carinal resection and airway reconstruction was most frequently applied for these diseases [2]. However, tracheal surgery is technically challenging and is associated with high rates of operative morbidity and mortality. Effective neoadjuvant treatment is expected to reduce the tumor load and lessen the extent of resecting primary tracheal tumors. However, evidence regarding neoadjuvant treatment for tracheal tumors remains relatively scarce and platinumbased doublet chemotherapy remains the standard in this setting. Immune checkpoint inhibitors are a promising approach to neoadjuvant treatment. A phase II clinical trial (NADIM[3]) evaluated nivolumab with paclitaxel plus carboplatin as neoadjuvant regiment for resectable stage IIIA non-small cell lung cancer. The major pathological response rate was 83%, and the pathological complete response rate was 63% [3]. The updated results of the phase III trial (Checkmate 816) showed that neoadjuvant nivolumab in combination with platinum-based chemotherapy could significantly improve pathological complete response rate compared to chemotherapy alone (24.0% vs. 2.2%, odds ratio = 13.94, 99% confidence interval [CI] = 3.49-55.75) [4]. Hence, to deepen our understanding on the treatment of primary tracheal tumors, we report the application of neoadjuvant immunochemotherapy in two rare tracheal tumor cases.Case 1: A 57-year-old woman presented with a gradually worsening cough for 2 weeks. She had no history of cardiothoracic operation or tuberculosis. Chest computerized tomography (CT) revealed a rounded, solid nodule measuring approximately 1.1 cm in diameter, located at the opening of the right main bronchus, with no clear boundary. 18F-FDG positron emission tomography-computed

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“…Ben-Yuan Jiang 1,# Jia-Tao Zhang 1,# Li-Xu Yan 2 Xiang-Peng Chu 1 Qiang Nie 1 Jian-Xiu Cui 3 Xue-Ning Yang 1 Wen-Zhao Zhong 1 Yi-Long Wu…”

Section: A U T H O R S H I Pmentioning

confidence: 99%

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mentioning

confidence: 99%

Neoadjuvant immune checkpoint inhibitor plus chemotherapy in rare tracheal tumors

Jiang¹,

Zhang²,

Yan

et al. 2021

Cancer Communications

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“…Surgical treatment is usually the most important treatment for TBT (2)(3)(4). Survival after diagnosis was significantly longer for patients undergoing curative intent resection, with a median overall survival (OS) of 82-198 months, as compared with 3-92 months for patients who did not undergo surgery (2,(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of primary tracheobronchial tumors: 16-year experience in a single center

Liu¹,

Zheng²,

Lu³

et al. 2022

J Thorac Dis

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Background: Primary tracheobronchial tumor (TBT) is a rare disease, and the prognostic factors of surgical treatment have not been well identified.Methods: Patients with primary TBT and accepted surgical treatment between January 2004 and January 2020 at our institution were retrospectively analyzed. The univariate analysis and multivariate analysis were conducted on the malignant cases. The overall survival (OS) was analyzed using Kaplan-Meier method, and potential prognostic factors were analyzed using Cox regression analysis.Results: A total of 69 patients (29 males and 40 females) were included. The median follow-up duration was 75.7 months (1.2-177.4 months). The most common histology was adenoid cystic carcinoma (ACC) (37.7%) followed by squamous cell carcinoma (SCC) (23.2%). For patients with malignant tumors, the estimated 5-year OS of the overall population was 77.2% and the estimated 5-year OS of SCC patients was 73.8% especially. The univariate Cox regression analysis identified that age and tumor size had significant effects on OS. The multivariate analysis showed that age (≤50 years or >50 years) was independent prognostic factor for OS (P<0.05).Conclusions: Age is independent factor affecting the OS of primary TBT treated by surgery. And patients of TBT with younger age should be much more referred for surgery.

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“…Other histological subtypes, including mucoepidermoid carcinoma, sarcoma, plasmacytoma, lymphoepithelioma etc. are much rare (5). Surgical resection is the most effective treatment for primary tracheobronchial neoplasm (6).…”

Section: Introductionmentioning

confidence: 99%

PD-L1 expression and immune cells infiltration in primary tracheobronchial neoplasm

Zheng¹,

Liu²,

Ma³

et al. 2021

Transl Lung Cancer Res

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Background: Primary tracheobronchial neoplasm is rare yet poses a serious threat to life. Due to its low incidence, the immune microenvironment of such tumors remained unclear. This study aimed to clarify the expression of programmed death-ligand 1 (PD-L1) and infiltration of immune cells in primary tracheobronchial neoplasm, which might be useful for guiding treatment and evaluating clinical outcome. Methods:We assessed retrospectively the expression of PD-L1 and infiltration in cells expressing CD8, CD16, CD68, CD163 and FOXP3 in 21 patients with primary tracheobronchial neoplasm who underwent surgery in Tangdu Hospital from January 2016 to July 2021. The expression of PD-L1 was assessed based on the tumor proportion score system. The density of immune cells was analyzed by automatic image analysis software.Results: In this study, all of 16 participants with adenoid cystic carcinoma (ACC) had no expression of PD-L1, whereas 4/5 (80%) of those with squamous cell carcinomas (SCC) were positive for PD-L1 expression.Compared with ACC, the density of FOXP3 + cells in both the intratumoral region and peritumoral region was higher in SCC (P<0.01). The density of FOXP3 + cells was significantly higher than that of CD8 + , CD16 + , and CD163 + cells in SCC in the intratumoral region (P<0.01). In contrast, the density of FOXP3 + cells was significantly lower than that of CD8 + , CD16 + , and CD68 + cells in ACC in both the intratumoral region and peritumoral regions. The density of CD68 + cells was significantly higher than that of CD8 + cells (P<0.05) and CD163 + cells (P<0.01) in ACC in the intratumoral region. Furthermore, the tumors of patients with metastasis more commonly of immune-excluded status, in which the CD8 + cells accumulated in peritumoral region.Conclusions: This study demonstrated that the expression of PD-L1 in primary tracheobronchial neoplasm was mainly concentrated in patients with SCC. In the immune microenvironment of SCC, FOXP3 + cells were the dominant immune cells, while in the immune microenvironment of ACC, CD68 + 2 Zheng et al. The immune microenvironment of tracheobronchial neoplasm

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Demography, patterns of care and survival outcomes in patients with malignant tumors of trachea: A systematic review and individual patient data analysis of 733 patients

Cited by 23 publications

References 8 publications

Neoadjuvant immune checkpoint inhibitor plus chemotherapy in rare tracheal tumors

Neoadjuvant immune checkpoint inhibitor plus chemotherapy in rare tracheal tumors

Surgical treatment of primary tracheobronchial tumors: 16-year experience in a single center

PD-L1 expression and immune cells infiltration in primary tracheobronchial neoplasm

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