Objective: To explore the clinical value of endoscopic interventional therapy for locally recurrent primary lung adenoid cystic carcinoma (ACC). Methods: The clinical data of 42 patients with locally recurrent ACC were retrospectively analyzed, and the differences of tracheal and bronchial diameter, airway scoring grade and airway obstruction degree before and after treatment were compared among three treatment methods: bronchoscopic interventional therapy + palliative radiotherapy, interventional therapy alone, and non-interventional therapy. Log rank test and Cox proportional risk model multi-factor analysis were used to determine the prognostic factors of ACC patients with local recurrence, and the long-term effect of bronchoscopic interventional therapy on ACC with local recurrence was determined. Results: The median overall survival of 42 patients was 59 months and 5-year survival rate was 54.2%.Univariate analysis showed that vascularized cancer, pleural invasion, pulmonary atelectasis, incisal margin, microscopic classification, tumor diameter, initial TNM stage, ki-67 index, and treatment after local recurrence were associated with long-term survival of ACC patients with local recurrence (all P<0.05). Cox multivariate regression analysis showed that margin status (RR=0.272, P=0.011), tumor diameter (RR=2.586, P=0.005), initial TNM staging (RR=0.369, P=0.035), ki-67 index (RR=3.569, P<0.001), and treatment methods after local recurrence (RR=0.126, P<0.001) were independent factors influencing the prognosis of ACC patients with local recurrence. After three months of treatment, the tracheal bronchus diameters, rating of shortness of breath, and degree of airway obstruction were all improved significantly (all P<0.05), both in the interventional therapy + palliative radiotherapy group [(14.5±2.8 mm, 0.86±0.45, (14.50±10.67)%, respectively], and the interventional therapy alone group [(13.7±2.3) mm, 0.97±0.25, (15.38±12.02)%, respectively]. Meanwhile, the difference before and after non-interventional therapy was not statistically significant (all P>0.05). 5-year overall survival rates were 55.8%, 46.6% and 42.6% for patients undergoing interventional therapy+ palliative radiotherapy, interventional therapy alone, and non-interventional therapy after recurrence, with statistically significant differences (P=0.015). Patients underwent bronchial endoscopic interventional therapy and palliative radiotherapy had the best efficacy of treatment. Conclusion: Endoscopic interventional therapy plus palliative radiotherapy is an effective local palliative treatment for locally recurrent ACC patients, which can rapidly relieve airway stenosis, improve the quality of life of patients and prolong the survival time of patients.
目的： 探讨经支气管镜介入疗法治疗局部复发肺原发性腺样囊性癌(ACC)的临床价值。 方法： 回顾性分析42例局部复发ACC患者的临床资料，比较经支气管镜介入治疗＋姑息放疗、单纯介入治疗、非介入治疗3种治疗方法治疗前后患者气管支气管直径、气促评分等级、气道阻塞程度的差异。采用log rank检验和Cox比例风险模型多因素分析明确局部复发ACC患者的预后影响因素，明确经支气管镜介入治疗对局部复发ACC的远期疗效。 结果： 42例患者中位总生存时间为59个月，5年生存率为54.2%。单因素分析显示，脉管癌栓、胸膜侵犯、肺不张、切缘状况、镜下分型、肿瘤直径、初始TNM分期、Ki－67指数、局部复发后治疗方法与局部复发ACC患者的远期生存有关(均P<0.05)。Cox多因素回归分析显示，切缘状况(RR＝0.272，P＝0.011)、肿瘤直径(RR＝2.586，P＝0.005)、初始TNM分期(RR＝0.369，P＝0.035)、Ki－67指数(RR＝3.569，P<0.001)、局部复发后治疗方法(RR＝0.126，P<0.001)是局部复发ACC患者预后的独立影响因素。复发后行介入治疗＋姑息放疗的患者治疗后3个月的气管支气管直径、气促评分等级、气道阻塞程度分别为(14.5±2.8)mm、(0.86±0.45)级和(14.50±10.67)%，行介入治疗的患者治疗后3个月的气管支气管直径、气促评分等级、气道阻塞程度分别为(13.7±2.3)mm、(0.97±0.25)级和(15.38±12.02)%，均较治疗前明显改善(均P<0.05)，而行非介入治疗的患者，治疗前后差异无统计学意义(均P>0.05)。复发后行介入治疗＋姑息放疗、介入治疗、非介入治疗患者的5年生存率分别为55.8%、46.6%和42.6%，差异有统计学意义(P＝0.015)，其中经支气管镜介入治疗＋姑息放疗组疗效最优。 结论： 经支气管镜介入治疗＋姑息放疗是局部复发ACC患者的有效局部姑息治疗方法，能迅速缓解气道狭窄，提高患者的生活质量，延长患者的生存时间。.
Keywords: Carcinoma, adenoid cystic; Interventional therapy; Neoplasm recurrence, local; Prognosis.