Outcomes and prognostic insights in primary tracheal cancer: a multicenter retrospective study

Primary tracheal tumors are exceedingly rare, comprising less than 0.1% of all respiratory system cancers and only 0.02-0.04% of all malignancies. Their rarity and clinical heterogeneity present significant challenges for diagnosis and treatment. This study aimed to evaluate treatment outcomes, identify prognostic factors, and compare recent findings with historical data to assess changes in clinical practice.

We conducted a retrospective analysis of 31 patients treated between 2017 and 2022 at Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw and Gliwice, Poland. Demographic, clinical, pathological, and treatment-related data were collected. Overall survival (OS) was estimated using the Kaplan-Meier method, and prognostic factors were assessed using Cox proportional hazards models.

The most common histological types were squamous cell carcinoma (SCC, 51.7%) and adenoid cystic carcinoma (ACC, 29.0%). Among patients treated with curative intent, 60% underwent surgery and 40% received radical radiotherapy. All ACC patients were surgically treated, while 83% of SCC patients received radiotherapy. Radical treatment resulted in significantly better 5-year OS (35.7%) compared to palliative care (0%, P=0.002). Female sex (5-year OS: 55.3% vs. 0%, P<0.001), good performance status [World Health Organization (WHO) 0-1, P=0.001], and absence of nodal involvement (N0, P<0.001) were associated with improved survival.

Female sex, good performance status, and absence of nodal metastases were favorable prognostic factors. Radical treatment significantly improved outcomes, emphasizing the importance of early diagnosis and multidisciplinary management. Further multicenter studies are needed to establish optimal treatment strategies for this rare malignancy.