Tracheal cancer epidemiology and survival trends: A SEER database analysis.
Authors: Princy Shah, Kashyap Kela, Upendra P. Hegde
Journal: Journal of Clinical Oncology (2024)

e20078 Background: Tracheal cancer is one of the rarest malignancies of the respiratory system and, hence one of the least studied ones. It has a poor prognosis and understanding its epidemiology can help with effective diagnosis and management. Here we present the Surveillance, Epidemiology, and End Results (SEER) analysis of tracheal cancer. Methods: Information was obtained from the SEER database November 2022 with 17 registries for years 2000-2022. Case selection was done for the Primary labeled site Trachea C 33.9. Only patients with age &gt;20 years and with one primary cancer were included. A total of 537 Patients were analyzed for incidence and survival based on Histology, Age, Gender, Race, Household Income, Area of residence, and treatment received. Results: The most common histology was squamous cell carcinoma (34%),followed by adenoid cystic carcinoma (23%) and Small cell carcinoma (4%). Other histologies (39%) included but were not limited to Large cell carcinoma, adenoid carcinoma, mucoepidermoid carcinoma, etc. The age group studied was 15 years and above. The most common age group affected was 65-69 years (12.3%), closely followed by 60-64 years (12.1%). The mean age of population was 62.5 +/- 14.7 years. Out of the total,56% were males and 44% were females (P value (P) &lt; 0.002). 68.7% of cases were observed in Non-Hispanic Whites, (P &lt;0.0001) followed by Blacks (11.4%), Hispanics (9.3%), Asian/Pacific Islanders (9.9%). 83% of the population was residing in metropolitan versus 17% in non-metropolitan regions (P&lt;0.0001). 38% cases were observed in Annual household Income of &gt;75,000 US dollars (USD) versus 62% in &lt;75,000 USD (P &lt;0.0006). Overall 5-year survival of tracheal cancer was noted to be 27%. Surgery was done in 40% of the cases. Poor 5-year survival was observed in those who did not have surgery compared to those who did(Hazard ratio (HR)=1.45, Confidence Interval (CI) 1.23-1.71, P &lt;0.0001). Radiation was done in 28.1% of cases. Patients who received no radiation therapy had poor outcome compared to those who did. (HR=1.214, CI 1.066-1.383, P &lt;0.0001). White race had worse outcomes compared to other races (HR 1.14, CI 1.003-1.289, P&lt;0.023). The risk of death at 5 years in Males was slightly higher than in females but not statistically significant (HR 1.067, CI 0.96-1.18). Difference was also not significant in those with Household income &lt;75,000 USD compared to those with more than &gt;75,000 USD (HR 0.92 CI 0.83-1.01), Metropolitan versus non-metropolitan areas of residence (P=0.14). Conclusions: Statistically significant improvement in survival has been noted in patients who received the treatments including surgery or radiation in tracheal cancer versus patients who didn’t. Our study suggests that less than half of the patients received surgery and less than one-third of the patients received radiation therapy. Efforts should be made to emphasize the continued utilization of these therapy options for better outcomes.