Evolution of treatment and survival in primary tracheal cancer: Insights from a global real-world dataset.

Abstract

e18141 Background: Primary tracheal cancer is a rare malignancy associated with poor survival and highly heterogeneous treatment patterns. Studies have demonstrated that only a small proportion of patients receive definitive therapies. Our aim was to evaluate the differences in treatment patterns between two diagnostic eras and to assess the impact of evolving practices on outcomes in primary tracheal cancer. Methods: We conducted a multi-center retrospective study of patients ≥18 years old with primary tracheal cancer using TriNetX, a global database of de-identified electronic health records.Two diagnostic eras were defined: pre-2010 (2000-2009) and post-2015 (2015-2024). Propensity score matching controlled for confounding variables including age, sex, race, ethnicity, histology (squamous cell vs adenoid cystic carcinomas) and metastases. Treatment patterns, Kaplan-Meier overall survival (OS) and mortality risk were compared between the two cohorts. Results: A total of 7315 patients were included (1919 pre-2010 and 5396 post-2015). The annual number of new tracheal cancer diagnoses increased significantly over time. Surgical resection was recorded as 10% in the pre-2010 cohort compared to 27% in the post-2015 cohort, suggesting increased use of definitive surgical resection. Radiation +- chemotherapy was 25% in the pre-2010 cohort and 29% in the post-2015 cohort. Immunotherapy was <1% in the pre-2010 cohort vs 10% in the post-2015 cohort. A substantial proportion of patients: 63% in the pre-2010 cohort and 43% in the post-2015 cohort had no recorded curative-intent therapy. After propensity score matching, 513 patients were included in each cohort. Kaplan–Meier analysis showed a better 3 year OS (58% vs 50%; log rank test p=0.0072) and 5 year OS (52% vs 43%, log rank test p=0.0063) in the post-2015 cohort compared to the pre-2010 cohort. Median survival was significantly better in the post-2015 cohort (2026 days, 39% in the post-2015 group vs 1083 days, 16% in the pre-2010 group; log rank test p=0.0078). Mortality risk was higher in the pre-2010 cohort (65% for pre-2010 vs. 43% for post-2015; risk difference is 22%; 95% CI (16.25%-28.25%);p<0.0001). Conclusions: Overall survival for primary tracheal cancer has improved, coinciding with increases in surgical resection. This likely reflects better diagnosis of this rare disease and enhancements in surgical techniques, facilitating the feasibility of definitive resection. Nonetheless, persistently high rates with nearly half of the patients with non-curative intent therapies highlight ongoing barriers to improve survival outcomes in primary tracheal cancer.