Prognostic Factors and Treatment Outcomes in Pulmonary Adenoid Cystic Carcinoma
Esra Zeynelgil1, Nesrin Gürçay2, Tülay Eren1, Abdulkadir Kocanoglu3, Selahattin Çelik1, Serdar Karakaya31Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Türkiye, 2Department of Patology, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye, 3Department of Medical Oncology, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye
Objectives: Pulmonary adenoid cystic carcinoma (PACC) is a rare primary tumor of the lung, representing less than 1% of all pulmonary malignancies. There is no strong evidence for cryotherapy, radiotherapy, and adjuvant chemotherapy in patients with PACC. Methods: Data from patients who underwent surgery for pulmonary adenoid cystic carcinoma between January 2009 and November 2024 were retrospectively analyzed. Clinical data, surgical approaches, markers at the time of diagnosis, and adjuvant therapies were included in the analysis. Prognostic factors potentially affecting recurrence-free survival and overall survival were analyzed using Cox regression analysis. Results: A total of 45 patients were included in the study. The median age was 61 years (range: 24–81), and 26 patients (57.8%) were male. Tumors were most commonly located in the lung lobes (n=29, 64.4%), and the most frequent histo logical subtype was the mixed type (n=19, 42.2%). Among mixed subtypes, the most prevalent pattern was a combina tion of cribriform and solid architecture (n=12). The median recurrence-free survival (RFS) for the entire cohort was 82.8 months (95% CI: 53.4–112.1), and the median overall survival (OS) was 145.5 months (95% CI: 76.9–214.0). The 5-year OS rate was 84.4% (n=7 deaths), and the 10-year OS rate was 73.3% (n=12 deaths). Lymph node metastasis (HR: 4.19, 95% CI: 1.82–9.63, p=0.001) and increased Ki-67 expression (HR: 1.06, 95% CI: 1.02–1.09, p=0.001) were significantly associ ated with shorter RFS. Radiotherapy did not demonstrate a statistically significant impact on recurrence-free survival (HR: 0.56, 95% CI: 0.25-1.24, p=0.149). No other clinical or pathological factors were found to be significantly associated with RFS. In the analysis of factors associated with OS, receiving adjuvant radiotherapy was found to be a favorable prognostic factor (HR: 0.27, 95% CI: 0.10-0.71, p=0.008). In contrast, lymph node metastasis (HR: 3.71, 95% CI: 1.33–10.39, p=0.012) and elevated Ki-67 index (HR: 1.04, 95% CI: 1.00–1.08, p=0.031) were identified as negative prognostic mark ers. No statistically significant difference in OS was observed between patients undergoing surgical resection and those treated with cryotherapy (HR: 2.56, 95% CI: 0.89–7.38, p=0.083). Conclusion: Adjuvant radiotherapy was associated with improved overall survival, whereas lymph node metastasis and elevated Ki-67 expression were identified as unfavorable prognostic indicators. Adjuvant chemotherapy did not appear to provide a survival benefit. Although cryotherapy yielded comparable survival outcomes to surgical resection in this limited cohort, the difference was not statistically significant. Therefore, cryotherapy may be considered a feasible alter native for patients who are medically inoperable or unsuitable for surgery. Larger multicenter and prospective studies are needed to validate these findings and to optimize treatment strategies for this rare malign
Cite This Article
Zeynelgil E, Gürçay N, Eren T, Kocanoglu A, Çelik S, Karakaya S. Prognostic Factors and Treatment Outcomes in Pulmonary Adenoid Cystic Carcinoma. EJMI. 2025; 9(4): 220-226
Corresponding Author: Esra Zeynelgil