| Background and purposePrimary tracheobronchial salivary gland-type cancers(PTSC)is a group of rare lower respiratory tract cancers with unique clinical manifestations.The most common tumors in this group are tracheobronchial adenoid cystic carcinoma(TACC)and tracheobronchial mucoepidermoid carcinoma(TMEC),which represent more than 90%of PTSCs.Due to the rarity of PTSCs,there have been only a few small-sample size studies regarding this disease;thus,the spectrum of demographics,clinical behavior,treatment,and prognosis of PTSCs,as well as the prognostic factors,have not been well defined.MethodsWe performed a retrospective review of all patients pathologically diagnosed with PTSCs between 1965 and 2017 at National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences.We reviewed the patients’ information and compared the clinicopathological characteristics and prognosis of TMEC and TACC patients.Survival curves were estimated via the Kaplan-Meier method and compared using a log-rank test.Potential factors affecting survival were explored using Cox regression model analysis.ResultsA total of 306 consecutive patients,including 191 TACC and 8 TMEC,were included in our study.The mean age of TACC patients was 49;the incidence was similar between men and women(male,50%);the majority of patients(68%)had no smoking history;most patients(95%)had symptoms,and the main symptoms were cough or dyspnea;most tumors(65%)were located in the trachea;the majority of patients(86%)underwent surgical treatment.The mean age of TMEC patients was 40;the incidence of male(56%)was slightly higher than that of female;the majority of patients(77%)had no smoking history;most patients(86%)had symptoms,and the main symptoms were cough or dyspnea;most tumors(89%)were located in the trachea;the majority of patients(93%)underwent surgical treatment.TMEC patients were younger,had a shorter complaint duration,had fewer symptoms,had more bronchial tumors,and were more likely to undergo surgical treatment and achieve an R0 resection(surgically treated patients)than TACC patients(P<0.05);furthermore,TMEC patients had a significantly better overall survival(OS)than TACC patients(P<0.05).A total of 191 consecutive patients were included in our study.One hundred sixty-three patients underwent surgery,while the remaining 28 patients received nonoperative therapy.The 5-,10-,and 20-year survival rates of the surgical group were 85.00%,63.40%,and 47.00%,while the 5-and 10-year survival rates of the nonoperative group were 63.70%and 46.40%,respectively.The multivariate analysis showed that the complaint duration(<7 months or>7 months)and treatment methods(R0 resection,R1 resection with radiotherapy,R1 resection without radiotherapy)were independent prognostic factors for disease-free survival of the R0/1(resection with no residual tumor or microscopic residual tumor)resected patients,while the tumor size(≤ 3 cm or>3 cm)and treatment methods were independent prognostic factors for the overall survival.Sixty-four(45.1%)patients in the R0/1 group experienced recurrence/progression,and compared with chemotherapy or supportive treatment,local treatment significantly improved the prognosis of these patients(P<0.05).A total of 115 consecutive patients,including 107 who underwent surgery and 8 who received nonoperative therapy,were included in our study.The 1-,2-,and 5-year survival rates were 97.89%,94.17%and 90.50%,respectively,in the surgical group and 83.33%,41.67%and 0.00%,respectively,in the nonoperative group.The multivariate analysis showed that N stage was an independent prognostic factor for OS.ConclusionsTMEC has different characteristics and a better prognosis than TACC,which may reflect the different biological behaviors of these two salivary gland neoplasms.The complaint duration and tumor size are independent prognostic factors for disease-free survival and overall survival in TACC,respectively.Complete resection of the primary tumor,postoperative adjuvant radiotherapy for patients with positive margins,and local treatment after postoperative recurrence/progression may contribute to better survival.Radical treatment and close follow-up are critical for surgically treated TMEC patients with lymph node metastasis.BackgroundThe 8th edition lung cancer staging system was the first to describe the detailed diagnosis and staging of multiple primary lung cancers(MPLC).However,the characteristics and prognosis of the different disease patterns of MPLC categorized according to the new system have not been evaluated.MethodWe retrospectively analyzed data from surgically treated MPLC patients in a single center from 2011 to 2013 and explored the characteristics and outcomes of different MPLC disease patterns.ResultsIn total,202 surgically treated MPLC patients were identified and classified into different groups according to disease categories and diagnostic time(multifocal ground glass/lepidic(GG/L)nodules:n=139,second primary lung cancer(SPLC):n=63,simultaneous MPLC(sMPLC):n=171,and metachronous MPLC(mMPLC):n=31).There were significant differences in clinical characteristics between SPLC and GG/L nodule patients and simultaneous and metachronous MPLC patients.The overall 1-,3-,and 5-year lung cancer-specific survival rates of MPLC were 97.98%,90.18%,and 82.81%,respectively.Five-year survival was better in patients with multiple GG/L nodules than in those with SPLC(87.94%vs.71.29%,P<0.05).Sex was an independent prognostic factor for sMPLC(5-year survival,female vs.male,88.0%vs.69.5%,P<0.05),and in multiple tumors,the highest tumor stage was an independent prognostic factor for all categories of MPLC.ConclusionsThe different disease patterns of MPLC have significantly different characteristics and prognoses.Clinicians should place treatment emphasis on the tumor with the highest stage as it is the main contributor to the prognosis of all categories of MPLC patients.ObjectiveThe number of multiple primary lung cancer(MPLC)patients has rapidly increased in recent years.However,clues to molecular genetics related to etiology and EGFR-tyrosine kinase inhibitor(TKI)treatment responsiveness in MPLC are relatively rare.To describe unique mutation signatures of EGFR in MPLC,we screened germline and somatic mutations in MPLC probands from 162 families and reanalyzed the frequencies of somatic mutations in 3243 lung adenocarcinoma patients from our collaborating laboratory.MethodsPolymerase chain reaction(PCR)and Sanger sequencing were used to screen EGFR mutations in 162 MPLC family probands(162 normal tissue samples and 366 tumor lesion samples).The frequencies of germline and somatic mutations were calculated.Ten-gene panel target sequencing data for 3243 lung adenocarcinoma patient samples from our collaborating laboratory were reanalyzed to identify the EGFR somatic mutation frequency.ResultsGermline mutations occurred in exon 19(p.del;3,1.85%),exon 20(8,4.94%)and exon 21(5,3.10%),with a total frequency of 9.88%in the 162 MPLC normal tissue samples(16/162).A total of 63 somatic mutant probands(63/162,38.89%)were identified,including exon 18 p.G719S(1,0.62%),19 p.del(21,12.96%),and 20 p.delins(8,4.94%)and missense mutations in exons 20(10,6.17%)and 21(34,20.99%).Among 63 probands,eight patients had multiple mutations at the same time.However,only 9 cases showed consistency among tumor lesions(366 tumor lesions);we also identified EGFR somatic variation in 3243 lung adenocarcinoma patients(55.94%),with exon 18 p.G719A/S/C(78,2.41%),19 p.del(668,20.60%),20 p.delins(4,0.12%),21 p.L858R(911,28.09%)and 21 p.L861Q(36,1.11%)and missense mutations in exon 20(116,3.58%).ConclusionThis study is the first to show unique EGFR mutation signatures in MPLC probands:high-frequency EGFR germline mutations,such as exon 19 p.del,20 p.delins,20 p.S768I/N and 21 p.L861R,were first screened in MPLC family members.Significantly higher frequencies of exon 19 p.747-752del,20 p.V769delinsVASV and 20 p.D770delinsDSVD were also identified in MPLC family members compared with sporadic lung adenocarcinoma patients.All these results might provide evidence related to the etiology,prescreening and clinical treatment of high-risk patients. |
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