目的：评估中国医学科学院肿瘤医院手术治疗的颈段气管原发恶性肿瘤临床特征、治疗经验及生存预后，并对比分析国外数据库中气管原发恶性肿瘤特征及生存预后。

方法：回顾性分析中国医学科学院肿瘤医院2000年至2020年期间接受手术治疗的颈段气管原发恶性肿瘤患者，通过回顾病历收集临床和手术特征并进行随访。通过收集SEER数据库中2000年至2020年间原发性气管恶性肿瘤患者数据对比。资料主要包括：年龄、性别、病理类型、吸烟史、肿瘤史、并发症、初始症状、肿瘤侵犯范围、淋巴结转移情况、辅助治疗情况、手术方式、切缘病理、生存时间和生存状态，进行比较分析。根据不同病理类型评估影响预后的因素。

结果：本中心临床数据共纳入64例患者，其中59.3％为男性，平均年龄为48.8±12.8岁。最常见的组织学亚型是腺样囊性癌（60.9％），其次是鳞状细胞癌（12.5％）。在分析的患者中，51.5％的原发性肿瘤侵犯了邻近器官，3.1％的患者有淋巴结受累。气管袖状切除短短吻合术是主要的手术方式，其次是皮瓣修复气管重建术。59.4％的患者进行了根治性切除，30例（46.9％）患者接受了辅助治疗。与腺样囊性癌相比，鳞状细胞癌患者存在淋巴结转移和并发症的风险显著增加。整个队列的5年总生存率为86.3％，10年总生存率为58.0%，单因素回归分析发现年龄、肿瘤直径、淋巴结转移和术后并发症发生是腺样囊性癌与鳞状细胞癌外科治疗与生存的相关因素，多因素回归分析所得与预后不良相关的因素为术后并发症的发生（p=0.049）。外部数据库数据研究共纳入308例患者，其中行完整及根治性手术切除治疗的患者共190例，其中病理类型最多为腺样囊性癌（47.3%），其次为鳞状细胞癌（34.2%）。接受完整或根治性切除手术的患者中，5年和10年的生存率分别是71.5%和51.2%。完整或根治性切除手术与仅活检或部分切除患者相比，存在显著生存差异（p<0.01）。进一步多因素回归分析均表明在不同病理类型中，完整切除病变是生存的显著保护因素（p<0.01），腺样囊性癌预后与年龄相关，鳞状细胞癌预后与是否出现远处转移相关。

结论：颈段气管原发性恶性肿瘤的两种主要亚型是腺样囊性癌和鳞状细胞癌。外科治疗仍然是首选且有效延长生存的办法。年龄、肿瘤直径、淋巴结转移和术后并发症是接受手术治疗患者的与生存相关的因素。外部数据库对比得到了相同的结论。

Objective: To evaluate the clinical characteristics, surgical treatment, reconstruction strategies, and prognosis in individuals with cervical primary malignant tracheal tumors undergoing surgical intervention at the Department of Head and Neck Surgery in National Cancer Center, China. Compare these with the characteristics and survival prognosis of primary malignant tracheal tumors in SEER database.

Methods: A retrospective analysis was conducted on patients who underwent surgical treatment at the Chinese Academy of Medical Sciences, National Cancer Center, from 2000 to 2020. Clinical and surgical characteristics were collected through medical record review and followed up. Data of patients with primary malignant tracheal tumors between 2000 and 2020 were also collected from the SEER database for comparison. The main data included: age, gender, pathological type, smoking history, tumor history, complications, initial symptoms, tumor invasion range, lymph node metastasis, adjuvant therapy, surgical methods, margin pathology, survival time, and survival status, which were compared and analyzed. Prognostic factors were evaluated according to different pathological types.

Results: A total of 64 patients were included in the clinical data of our center, of which 59.3% were male, with an average age of 48.8±12.8 years. The most common histological subtype was adenoid cystic carcinoma (60.9%), followed by squamous cell carcinoma (12.5%). Among the analyzed patients, 51.5% had primary tumors that invaded adjacent organs, and 3.1% had lymph node involvement. Tracheal resection and reconstruction were the main surgical approach, accounting for half of all surgical treatments. 59.4% of the patients underwent radical resection, and 30 patients (46.9%) received adjuvant therapy. Compared to adenoid cystic carcinoma patients, individuals with squamous cell carcinoma had a significantly increased risk of lymph node metastasis and complications. The overall 5-year survival rate for the cohort was 86.3%, with a 10-year survival rate of 58.0%. Univariate regression analysis identified age, tumor diameter, lymph node metastasis, and postoperative complications as factors associated with survival among surgical patients, while multivariate regression analysis found that the occurrence of postoperative complications (p=0.049) was related to poor prognosis. The study of the external database included 308 patients, among whom 190 underwent complete and radical surgical resection. The most common pathological type was adenoid cystic carcinoma (47.3%), followed by squamous cell carcinoma (34.2%). Among patients who received complete or radical resection, the 5-year and 10-year survival rates were 71.5% and 51.2%, respectively. There was a significant difference in survival between patients who underwent complete or radical resection and those who only had a biopsy or partial resection (p<0.01). Further multivariate regression analysis indicated that complete resection of the lesion was a significant protective factor for survival (p<0.01) across different pathological types. Prognosis of adenoid cystic carcinoma was related to age, while that of squamous cell carcinoma was related to the presence of distant metastasis.

Conclusion: The two main subtypes of primary malignant tumors in the cervical trachea are adenoid cystic carcinoma and squamous cell carcinoma. Surgical treatment remains the preferred option and is effective in prolonging survival. Age, tumor diameter, lymph node metastasis, and postoperative complications are factors related to survival in patients undergoing surgical treatment. The comparison with the SEER database yielded the same conclusions.