Projection of the prevalence of tracheal, bronchus, and lung cancer incidence using cigarette smoking prevalence in Iran from 1990 to 2018: a comparison of latent period-based models with standard forecasting models.

BACKGROUND: Smoking is the major risk factor for tracheal, bronchus, and lung (TBL) cancers. We investigated the feasibility of projecting TBL cancer incidence using smoking incidence rates by incorporating a range of latent periods from the main risk factor exposure to TBL cancer diagnosis. METHODS: In this ecological study, we extracted data on TBL cancer incidence rates in Iran from 1990 to 2018 from the Global Burden of Disease (GBD) database. We also collected data on Iranian cigarette smoking patterns over the past 40 years through a literature review. The weighted average smoking incidence was calculated using a fixed-effects model with Comprehensive Meta-Analysis (CMA) software. Using these data, the five-year TBL cancer incidence in Iran was projected through time series modeling with IT Service Management (ITSM) 2000 software. A second model was developed based on cigarette smoking incidence using linear regression with SPSS (version 22), incorporating different latent periods. The results of these two models were compared to determine the best latent periods. RESULTS: An increasing trend in TBL cancer incidence was observed from 2019 to 2023 (first model: 10.30 [95% CI: 9.62, 10.99] to 11.42 [95% CI: 10.85, 11.99] per 100,000 people). In the second model, the most accurate prediction was obtained with latent periods of 17 to 20 years, with the best prediction using a 17-year latent period (10.13 to 11.40 per 100,000 people) and the smallest mean difference of 0.08 (0.84%) per 100,000 people using the standard forecasting model (the ARIMA model). CONCLUSION: Projecting an increase in TBL cancer incidence rates in the future, an optimal latent period of 17 to 20 years between exposure to cigarette smoke and TBL cancer incidence has implications for macrolevel preventive health policymaking to help reduce the burden of TBL cancer in upcoming years.

Global, regional, and national burden of trachea, bronchus, and lung cancer among women of reproductive age, 1990-2019.

BACKGROUND: Trachea, bronchus, and lung (TBL) cancer has demonstrated a discernible feminization and a tendency towards younger onset in recent decades. Therefore, our objective is to examine the most recent patterns in the worldwide prevalence of TBL among women of reproductive age on a global, regional, and national scale. METHODS: To assess the prevalence trends of TBL in women of reproductive age, we calculated the estimated annual percentage change (EAPC), age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and disability-adjusted life years (DALYs) for 204 countries and territories from 1990 to 2019. These calculations were based on the Global Burden of Disease (GBD) 2019 database. RESULTS: From 1990 to 2019, there was a global increase in the absolute number of incidence cases, deaths, and DALYs of TBL in women of reproductive age. However, the ASIR, ASDR, and age-standardized DALY rates were decreasing over this period, with EAPC of -0.77 (95 % confidence interval [CI]: -1.03 to -0.51), -1.08 (95 % CI: -1.34 to -0.82), and -1.10 (95 % CI: -1.36 to -0.84), respectively. This trend was observed even in regions with higher Socio-Demographic Index (SDI). East Asia consistently had the highest ASIR, ASDR, and age-standardized DALY rate, but there was a decreasing trend. Conversely, Eastern Sub-Saharan Africa displayed an increasing burden pattern. When examining countries individually, Monaco, Greenland, and Palau had the highest ASIR. Moreover, in most countries, the ASIR for TBL increased with age, particularly among women aged 35-49 years. CONCLUSIONS: Despite a global decline in ASIR, ASDR, and age-standardized DALY rates for TBL in women of reproductive age over the past three decades, there is still a troubling increase observed in low- and low-middle SDI regions. It is crucial to implement effective preventive and curative measures in these regions in order to address this concerning trend.

Tracheal cancer: a rare and deadly but potentially curable disease that also affects younger people.

OBJECTIVES: The incidence of tracheal cancer is low, few clinicians get much experience and the awareness may be low. Recent data on the treatment and outcome are limited. The aim of the present study was to present updated, national data on the incidence, characteristics, treatment and outcome for patients with tracheal cancer. METHODS: All tracheal cancers registered at the Cancer Registry of Norway in 2000-2020 were extracted. The patient and tumour characteristics age, sex, stage, histology and treatment modality (surgery and radiotherapy) were examined. Overall, median and relative survival were estimated. Cox regression models were used to identify independent prognostic factors. RESULTS: The 77 patients diagnosed with tracheal cancer equals a crude incidence rate and an age-standardized incidence rate of 0.075 and 0.046 per 100,000 per year respectively. The mean age was 63.8 years (range: 26-94). The numerical preponderance of men (n = 41) is not statistically significant. Eighteen patients (23.4%) were diagnosed in the localized stage. The 5-year overall survival was 31.7% [95% confidence interval (CI): 21.0-42.9], and in those treated with surgical resection or curative radiotherapy, it was 53.7% (95% CI: 26.1-75.0) and 37.8% (95% CI: 18.8-56.7), respectively. Age, histological type and treatment modality were identified as independent prognostic factors. CONCLUSIONS: Despite improved survival, the prognosis for patients with tracheal cancer is still poor. Few are diagnosed in the early stage and thus most are not eligible for curative treatment, mainly surgery. An increased awareness and diagnosis in the earlier stage is crucial.

Epidemiological trends of tracheal, bronchus, and lung cancer at the global, regional, and national levels: a population-based study.

BACKGROUND: Investigations of disease incidence, mortality, and disability-adjusted life years (DALYs) are valuable for facilitating preventive measures and health resource planning. We examined the tracheal, bronchus, and lung (TBL) cancer burdens worldwide according to sex, age, and social development index (SDI) at the global, regional, and national levels. METHODS: We assessed the TBL cancer burden using data from the Global Burden of Disease (GBD) database, including 21 regions, 195 countries, and territories in the diagnostic period 1990-2017. The data of TBL cancer-related mortality and DALYs attributable to all known risk factors were also analyzed. Age-standardized rates (ASRs) and their estimated annual percentage changes (EAPCs) were calculated. RESULTS: Incident cases, deaths, and DALYs of TBL cancer increased worldwide (100.44%, 82.30%, and 61.27%, respectively). The age-standardized incidence rate (ASIR) was stable (EAPC = 0.02, 95% confidence interval [CI] - 0.03 to 0.08), but the age-standardized death (EAPC = - 0.34, 95%CI - 0.38 to - 0.3) and DALY rate decreased generally (EAPC = - 0.74, 95%CI - 0.8 to - 0.68). However, the change trend of ASIR and ASDR among sexes was on the contrary. China and the USA always had the highest incidence, mortality, and DALYs of TBL cancer. Significant positive correlations between ASRs and SDI were observed, especially among females. High (36.86%), high-middle (28.78%), and middle SDI quintiles (24.91%) carried the majority burden of TBL cancer. Tobacco remained the top cause of TBL cancer death and DALYs, followed by air pollution, the leading cause in the low-middle and low-SDI quintiles. Metabolic risk-related TBL cancer mortality and DALYs among females increased but was stable among males. The main ages of TBL cancer onset and death were > 50 years, and the DALYs concentrated in 50 - 69 years. CONCLUSIONS: To significantly reduce the growing burden of TBL cancer, treatment resources need to be skewed according to factors such as risks and geography, especially for high-risk groups and high-burden areas. Asia had the greatest TBL cancer burden, followed by high-income North America. Tobacco remains the leading cause of death and DALYs, followed by air pollution. Effective prevention measures against tobacco and air pollution should be strengthened.

National Utilization of Surgery and Outcomes for Primary Tracheal Cancer in the United States.

BACKGROUND: Tracheal cancer (TC) is a rare disease, and surgical treatment requires a high level of expertise. We sought to determine the treatment patterns and surgical outcomes of TC in the United States. METHODS: The National Cancer Database was queried for all cases of primary invasive TC without distant metastatic disease between 2004 and 2015. Primary surgical treatment and outcomes were analyzed. Factors associated with utilization of surgery and overall survival were tested using regression analysis. RESULTS: Of 1379 identified TC patients, 338 patients (25%) were treated surgically. Among resected patients, most had adenoid cystic (48%) or squamous cell (28%) carcinoma. Median length of hospital stay after resection was 7 days (interquartile range, 3-8), and 30-day mortality was 1.4%. Most nonsurgically managed patients underwent radiation (63%). Factors associated with surgical resection were younger age, higher education level, tumor size, and adenoid cystic histology. On multivariate analysis patients were also more likely to undergo surgery if they traveled a farther distance for treatment (>45 km; odds ratio, 1.53; 95% confidence interval, 1.09-2.13) or were treated at academic centers (odds ratio, 1.68; 95% confidence interval, 1.25-2.26). Five-year overall survival was 71% after resection, 39% after surgical debulking, and 31% without surgery (P < .001). CONCLUSIONS: National surgical outcomes for resection of TC demonstrate low perioperative mortality and excellent long-term prognosis. However, few nonmetastatic TC patients underwent surgery, indicating disparities in access to optimal surgical care and variability in practice patterns at a national level.

Survival of malignant mesothelioma and other rare thoracic cancers in Germany and the United States: A population-based study.

Evidence on survival of malignant mesothelioma (MM) and other rare thoracic cancers is limited due to the rarity of these cancer sites. Here, we provide a comprehensive overview of MM incidence and survival after MM and other rare thoracic cancers in Germany and the United States (US). Incidence was estimated from a German National Cancer Database and from the Surveillance, Epidemiology and End Results (SEER) 18 database for 2000-2014. Patients diagnosed in 1997-2013 with malignant epithelial tumors of the trachea (Etra), epithelial tumors of the thymus (Ethy) and MM were extracted from a German cancer survival database and from the SEER 13 database. Period analysis was employed to compute 5-year relative survival (RS). During 2000-2014, an annual average of 0.9 and 0.6 MM cases per 100,000 person-years was diagnosed in Germany and the US. Rates decreased in Germany and in the US. Patients with Ethy had highest 5-year RS with US patients surviving longer (69.1% compared to 63.7%, p = 0.02). Survival after Etra was comparable in both countries (Germany 33.6%, US 34.4%, p = 0.07). Survival in MM patients was poor overall (Germany 11.8%, US 12.1%, p < 0.01). Survival improvements were only observed in MM patients in Germany (10.8% [2002-2007] vs. 13.0% [2008-2013], p < 0.01). The lack of progress in survival for Etra and Ethy patients underlines the need of novel preventive, therapeutic and diagnostic approaches. MM incidence significantly decreased in Germany and in the US. Further monitoring of MM incidence is warranted given that a peak in incidence is expected in 2020-2030 in Western countries.

[Surgery of tracheobronchial carcinoid tumours: Activity report]. / La chirurgie des tumeurs carcinoïdes trachéobronchiques : bilan d'activité.

INTRODUCTION: Our purpose is to evaluate our results of surgery for tracheobronchial carcinoid tumour as well as the long-term survival. METHODS: This is a retrospective and descriptive study performed in the department of thoracic surgery of CHU Hassan II (Marocco) over a period of 9 years. It concerns all patients with a tracheal or bronchial carcinoid tumour who underwent surgery. RESULTS: Twenty-three patients with a mean age of 39 years were operated on for 24 carcinoid tumours. The sex ratio was 0.29. The diagnostic delay ranged from 3 months to 8 years and the main symptom was haemoptysis in 74% of cases (n=17). The tumour was localized in the right bronchial tree in 70% of cases (n=16). The procedures performed were tracheal resection and end-to-end anastomosis in 1 case, lobectomy in 12 cases including 3 sleeve lobectomies, bilobectomy of middle and lower lobes in 7 cases and pneumonectomy in 4 cases. The prognosis was favourable in 91% after an average follow-up of 29 months. CONCLUSIONS: Surgery remains the only curative therapeutic option for tracheobronchial carcinoid tumours with acceptable morbidity and mortality.

Epidemiology and treatment trends for primary tracheal squamous cell carcinoma.

OBJECTIVE: Management of tracheal squamous cell carcinoma (TSCC) has been complicated by the lack of prognostic data and staging. We describe the epidemiology of TSCC and current treatment approaches. METHODS: Five hundred thirty-two adult patients with primary TSCC from 2004 to 2012 in the National Cancer Database were identified. Demographic, clinical factors, and 5-year overall survival were analyzed. Staging was classified as localized, regional extension, and distant spread. Treatment modality was defined as "no treatment (NT)," "limited surgery (LS)," "curative surgery (CS)," "LS with any adjuvant therapy (AT) (LS+AT)," "CS with AT (CS+AT)," "radiation therapy (RT)," or "chemoradiation (CRT)." RESULTS: Overall survival was 25%. Majority of cases were males, white, and occurred in sixth/seventh decades. Twenty-six percent of cases received CRT, 20% underwent LS+AT or CS+AT, 20% underwent LS or CS only, and 17% underwent RT alone. On multivariate analysis, CS (HR 0.42, 95% CI: 0.26-0.69), CS+AT (HR 0.44, 95% CI: 0.36-0.77), CRT (HR 0.48, 95% CI: 0.35-0.67), and RT (HR, 0.66 95% CI: 0.46-0.94) were associated with decreased likelihood of death compared to NT. Elderly patients and those with poor performance status had worse outcomes even on multivariate analysis. CONCLUSIONS: TSCC is increasingly treated with surgery and systemic therapy in addition to RT, with improved survival outcomes. CS, CS+AT, CRT, or RT provided improved survival advantage in patients with variable levels of improvement based on the extent of the disease. Prospective trials would help differentiate survival advantages between treatment modalities. Patients' goals of care, comorbidities, and age should be considered when deciding appropriate treatment recommendations. LEVEL OF EVIDENCE: NA Laryngoscope, 130:405-412, 2020.

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.

BACKGROUND: Malignant tumors of the trachea (MTT) account for 0.01-0.4% of all cancer cases. The rarity of the tumor along with different histologies makes it is a great challenge on how to optimally treat tracheal tumors and most of the available data is from small retrospective data series. We performed a systematic review and individual patient data analysis to evaluate the patterns of care and survival outcomes in patient with MTT. METHODOLOGY: A comprehensive search in Pub Med and Google scholar was done to find all possible publications related to malignant tumors of the trachea. The data on patient demograpphy, treatment, survival and recurrence pattern of individual patient was collected from the published data and was entered in a predesigned proforma. Progression free survival [PFS] and overall survival [OS] was calculated from the date of diagnosis to the date of documented progression and death respectively. Kaplan- Meier method was used for survival analysis and uni-variate analysis was performed using log rank test. SPSS v16 was used for all statistical analysis. RESULTS: 733 patients were included in this analysis. The most common histology was adenoid cystic carcinoma (ACC) followed by squamous cell carcinoma (SCC). The gender ratio was 4.43: 1[male: female] in patients with SCC while it was 0.85:1[male: female] in ACC. Smoking and age >50 years were associated with worse OS. The estimated median overall survival for entire cohort was 96 months. Survival was significantly better in patients with ACC than in patients with SCC [165 vs. 14 months, p < 0.001]. The use of definitive surgery was associated with a significantly better survival of 180 months when compared to 48 months with radiation as local therapy, [p < 0.001]. The radiation dose used also affected survival in patients with SCC with a better median OS of 24 months in patients who recieved more than 60 Gy vs 6 months in whom the dose was less than 60 Gy although not statistically significant (p = 0.011). CONCLUSION: ACC and SCC are the most common MTT. ACC has better prognosis compared to SCC. Surgery seems to provide better outcomes than radiation for ACC and sarcoma. Role of definitive radiotherapy versus surgery in SCC needs to be further studied.

Clinical epidemiology of tracheal invasion from thyroid cancer in Japanese population: Functional outcomes and effect of aging.

BACKGROUND: Although tracheal invasion from thyroid cancer is life-threatening, the epidemiology of its development remains unclear. This study aimed to determine the epidemiology (prevalence, incidence, and risk factors) and functional outcomes of tracheal invasion from thyroid cancer among Japanese patients who were eligible for full-layer tracheal resection. METHODS: Patients with thyroid cancer and with or without tracheal invasion were identified based on procedure codes using a large inpatient database that is maintained by a data vendor. The prevalence and incidence were estimated for each age and sex using Japanese volume of thyroidectomies and Japanese population data. We also explored whether a tumor-related tracheal defect was successfully reconstructed after full-layer tracheal resection. RESULTS: Among the 8482 patients with thyroid cancer, the overall prevalence of tracheal invasion was 0.4-0.7%. The overall incidence of thyroid cancer was 12.0/100,000 persons, and the incidence of tracheal invasion was estimated to be 0.05-0.09/100,000 persons. The age distributions were noticeably different between thyroid cancer cases with and without tracheal invasion. The highest incidence was observed at ages of 70-79 years for thyroid cancer with tracheal invasion and 60-69 years for thyroid cancer without invasion. Approximately one-half of patients experienced long-term use of a tracheal tube and/or multiple operations for tracheal reconstruction. CONCLUSION: The peak incidence of tracheal invasion from thyroid cancer was observed at ages of >70years. In addition, conventional surgical management appears to be limited in its ability to reconstruct tracheal defects.

Office-Based Subglottic Evaluation in Children With Risk of Subglottic Hemangioma.

PURPOSE: Children with V3 cutaneous infantile hemangiomas (IH) and PHACE syndrome have a high incidence for airway hemangioma, 29% and 52%, respectively. Therefore, a clinical evaluation for these high-risk children is essential. We report our experience with in-office lower airway evaluation (OLAE) in these high-risk children. RESULTS: Since 2003, 5 children with IH of the V3 cutaneous distribution and 3 children with PHACE syndrome underwent OLAE. Average age of presentation was 2.75 months. Two children had stridor at initial evaluation, and 1 child had subglottic hemangioma. This child was evaluated serially with OLAE to monitor disease progression and treatment response. A total of 10 upper tracheoscopies were performed on the 8 patients without respiratory complications. CONCLUSION: An airway evaluation is essential to evaluate and manage this high-risk population. Typically, operative endoscopy requires general anesthesia. However, in these high-risk children, we have performed OLAE without sedation to evaluate the trachea. High-speed recording and playback is essential in this method. Our series demonstrates that awake OLAE is possible and may be a safe technique to evaluate and monitor disease progression in these high-risk patients. These patients avoided general anesthesia and delay in diagnosis and did not incur any complications during or after OLAE.

Implantable cardioverter-defibrillators and subsequent cancer risk: a nationwide population-based cohort study.

AIMS: Despite increasing use of implantable cardioverter-defibrillators (ICDs) and reports linking selected bio-implants with cancer, the cancer risk associated with implanted ICDs remains unknown. The objective of our study was to examine cancer risk among ICD recipients. METHODS AND RESULTS: We conducted a population-based cohort study using medical registries covering the entire Danish population. We identified all first-time ICD recipients during the period of 2000-11 and determined their subsequent cancer incidence. Standardized incidence ratios (SIRs) were computed by comparing observed cancer incidence in the ICD cohort with expected cancer incidence based on national incidence rates according to age, sex, and year of diagnosis. A total of 6723 ICD recipients were followed for up to 12 years (median 2.8 years) and contributed a total of 23 254 person-years of follow-up. Compared with the general population, ICD recipients had a slightly elevated overall risk of cancer [SIR = 1.1 (95% confidence interval (CI): 1.0-1.2)]. This was driven by the cancer risk among patients with ischaemic heart disease (IHD) [SIR = 1.1 (95% CI: 1.0-1.3)], which, as expected, was particularly elevated for tobacco-related cancers [SIR = 1.4 (95% CI: 1.2-1.6)]. Importantly, ICD recipients without IHD were not at increased cancer risk [SIR = 1.0 (95% CI: 0.8-1.3)]. CONCLUSION: This nationwide population-based cohort study with up to 12-year follow-up did not indicate a causal relation between ICD implantation and cancer. However, more follow-up data are needed to entirely rule out risks for individual cancer types.

[Mucoepidermoid tracheo-bronchial tumors in adulthood. A series of 22 cases]. / Tumeurs muco-épidermoïdes trachéo-bronchiques chez l'adulte. À propos d'une série de 22 cas.

INTRODUCTION: Mucoepidermoid tumours (TME) are rare tumours arising from the submucosal glands of the tracheobronchial tree. The majority of these tumours develop in a benign fashion but some of them are malignant. The latter can be easily mistaken for adenosquamous carcinomas. PATIENTS AND METHOD: We have reviewed 22 patients suffering from TME observed over a period of 25 years. Two arose from the trachea and 20 from the cartilaginous bronchi; 12 of these tumours had macroscopic and histological criteria of low-grade malignancy, 4 had macroscopic and 6 macroscopic and microscopic criteria of high grade malignancy. RESULTS: Prognosis of the latter was very poor and no survival observed after 6 years follow-up, a behavior similar to that observed in non-small cell lung carcinomas and adenosquamous carcinomas. CONCLUSION: The best treatment of these orphan tumours remains surgery.

Management and prognosis of primary tracheal cancer: a national analysis.

OBJECTIVES/HYPOTHESIS: To perform a national review of the incidence and treatment of primary tracheal cancer and to identify gaps in service provision and factors associated with survival. STUDY DESIGN: Retrospective analysis of Hospital Episode Statistics data for England between 1996 and 2011. METHODS: Information about age, sex, morbidity, provider trust, diagnostic delay, nature of hospital admission and treatment, and palliation-free survival were recorded. The relationship between variables and survival was explored with Cox regression. RESULTS: There were 874 patients, giving an incidence of 0.9 per million. Mean age at diagnosis was 66 ± 13, and there were 456 (52%) males. Mean presentation to diagnosis latency was 2.5 ± 8 months, and 40% of patients presented as emergency admissions. There were 19 cases of oesophageal involvement and 241 cases of bronchopulmonary involvement; and 188 patients developed distant metastases. There were 60 curative resections (6.9%), which was the most significant predictor of palliation-free survival (hazard ratio: 0.23; 95% confidence interval 0.13-0.38). Other prognostic variables included age, sex, emergency admission, interventional bronchoscopy, chemotherapy, oesophageal involvement, and distant metastases. Ten-year palliation-free survival was 60.8% with curative resection and 19.5% overall. Eighty-six percent of patients were treated in units that treated fewer than one patient per year. CONCLUSION: Tracheal cancer is under-recognized and under-treated. Early diagnosis, access to interventional bronchoscopy, and surgical treatment in specialist units may improve the survival of patients with this condition.

Pathology of tracheal tumors.

Malignant involvement of the trachea predominantly results from direct spread of neighboring tumors to the tracheal wall. Primary tracheal malignancies show a low incidence of approximately 0.1 in every 100,000 persons per year, squamous cell carcinomas and adenoid cystic carcinomas accounting for about two-thirds of adult primary tracheal tumors. The etiology of squamous cell carcinoma and its premalignant lesions is strongly associated with tobacco smoking. Patients with tracheal malignancies show an unfavorable prognosis, with reported 5- and 10-year survival rates of 5% to 15% and 6% to 7%, respectively, for all types of tracheal carcinoma.

Rare thoracic cancers, including peritoneum mesothelioma.

Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) and followed-up to 31st December 2003. Over 17,688 cases of rare thoracic cancers were selected based on the list of the RACECARE project. Mesothelioma was the most common tumour (19 per million per year) followed by epithelial tumours of the trachea and thymus (1.3 and 1.7, respectively). The age standardised incidence rates of epithelial tumours of the trachea was double in Eastern and Southern Europe versus the other European regions: 2 per million per year. Epithelial tumours of the thymus had the lowest incidence in Northern and Eastern Europe and UK and Ireland(1) and somewhat higher incidence in Central and Southern Europe.(2) Highest incidence in mesothelioma was seen in UK and Ireland(23) and lowest in Eastern Europe.(4) Patients with tumours of the thymus had the best prognosis (1-year survival 85%, 66% at 5 years). Five year survival was lowest for the mesothelioma 5% compared to 14% of patients with tumours of the trachea. Mesothelioma was the most prevalent rare cancer (12,000 cases), followed by thymus (7000) and trachea (1400). Cancer Registry (CR) data play an important role in revealing the burden of rare thoracic cancers and monitoring the effect of regulations on asbestos use and smoking related policies.

Chinese pediatric and adolescent primary tracheobronchial tumors: a hospital-based study.

OBJECTIVES: To investigate the clinical characteristics and treatment outcomes in Chinese pediatric and adolescent patients with primary tracheobronchial tumors by focusing upon the exploration of prognostic factors. METHODS: A retrospective review of medical records collected from January 1996 through June 2009 was conducted within a single institution, inclusive of the total 19 treated pediatric and adolescent patients (3 benign tumors, 16 malignant tumors). A parallel comparison of adult cases with tracheobronchial tumor was performed to the pediatric and adolescent cases. RESULTS: The chart review of pediatric and adolescent case reports revealed 19 cases with primary tracheobronchial tumors. Final pathologic diagnosis included 14 (73.68%) mucoepidermoid carcinoma (ME), 2 (10.53%) carcinoid tumor, 2 (10.53%) papillomatosis and 1 (5.26%) neurofibroma. Median age upon diagnosis was 12 years (range 4-18 years). Chest imaging revealed common abnormal radiographic atelectasis (12/19). Patients with localized disease received surgical tumor resection. There were a total of 8 (42.1%) sleeve resections, 4 (21.1%) resection of anatomically related lung parenchyma (1 bilateral lobectomies, 2 lobectomies, 1 pneumonectomy) and 7 local tumor resections. No surgery-related deaths or complications were observed. 16 patients (84.2%) remained disease free with a median follow-up of 70.5 months (range 44-168 months). CONCLUSIONS: Our hospital data indicated a high incidence of ME, presenting the difference in the incidence rates between Chinese and western populations. Sleeve lobectomy provides efficient treatment with excellent prognosis among Chinese pediatric and adolescent patients.

Population based cancer registry analysis of primary tracheal carcinoma.

INTRODUCTION: Primary carcinomas of the trachea are rare tumors, occurring at a rate of 2.6 new cases per 1,000,000 people per year. This study investigates the large observational cohort of patients recorded in the NCI Surveillance, Epidemiology, and End Results (SEER) 1973-2004 database, and provides information regarding epidemiology, treatment, and prognosis. METHODS: The SEER database was investigated, and all patients for whom primary tracheal carcinoma was the first and only cancer were investigated. Demographic information was investigated. The cohort was analyzed for variables effecting survival, including age, gender, race, histology, extent of disease, extent of surgery, use of radiation, and year of diagnosis. RESULTS: Between 1973 and 2004, 578 cases of primary tracheal carcinomas were reported in the SEER database. There were 322 men (55.7%) and 256 women (44.3%). Squamous cell carcinoma was the predominant histology, representing 259 tumors (44.8%). Adenoid cystic carcinoma (ACC) was the second most common tumor (16.3%). Localized, regional and distant disease was found in 140 (24.2%), 212 (36.7%), and 108 (18.7%), respectively. Twenty percent of the patients did not undergo staging. Patients with localized disease had a better prognosis than those with regional (P = 0.001) or distant disease (P = <0.001).A significant fraction of patients did not receive cancer directed local therapy; 34.3% did not undergo surgery and 29.1% did not receive any kind of radiation therapy. There was a statistically significant improved survival for patients who underwent any type of surgery in comparison with patients who did not undergo cancer directed surgery. There was no statistical benefit for patients who underwent radiation therapy.General overall 5-year survival for all patients was 27.1% (95% CI: 23.1-33.3%). Patients with localized disease had a better outcome than patients with regional or distant disease with an overall 5-year survival of 46% (95% CI: 37.3%-55.8%). Squamous cell carcinoma tumors had worse outcomes than any other histologic type, with a 5 year overall survival of 12.6% (95% CI: 8.4-17.6%). In contrast, 5-year overall survival for AACs was relatively good at 74.3% (95% CI: 63.1-82.5). For localized disease, 5-year survival was 24.7% (95% CI: 12.8-38.7%) for squamous cell carcinoma versus 90.5% (95% CI: 73.3-96.8%) for ACCs (P < 0.001). CONCLUSION: Primary tracheal tumors are very uncommon; squamous cell carcinoma is the most common histologic type, followed by ACCs. General 5-year overall survival is poor, though localized disease has better survival when compared with regional or distant disease. There is a remarkable difference in survival between squamous cell carcinoma and ACC.

Clinical aspects and treatment of primary tracheal malignancies.

CONCLUSIONS: Selecting patients that are candidates for surgical treatment is important in the work-up of patients with tracheal cancer. Toward this goal, centralization of care concerning tracheal tumors is advised. Centralization may increase long-term survival and decrease operative morbidity and mortality even further. OBJECTIVE: Primary tracheal tumors pose a diagnostic and therapeutic challenge for the physician when confronted with this mostly malignant tumor. Diagnosis is often delayed for months or years due to its aspecific and asthma-mimicking symptoms. Knowledge from retrospective series is limited and few clinicians have gained experience with this tumor. The available literature on the diagnosis and management of this group of tumors is reviewed to summarize the available knowledge about these uncommon tumors. New diagnostic, staging, and treatment guidelines are proposed. METHODS: PubMed was searched for English publications from 1960. The available literature was reviewed and summarized. RESULTS: Surgical resection and primary reconstruction is the best curative treatment modality available at present. In centers of experience, more than half of all patients with tracheal cancer may be candidates for surgical resection, although in population-based studies this treatment is applied in only 10-25% of patients.