Ebright Michael I, Zakowski Maureen F, Martin Jocelyne, Venkatraman Ennapadam S, Miller Vincent A, Bains Manjit S, Downey Robert J, Korst Robert J, Kris Mark G, Rusch Valerie W
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Thorac Surg. 2002 Nov;74(5):1640-6; discussion 1646-7. doi: 10.1016/s0003-4975(02)03897-3.
The histologic criteria defining bronchioloalveolar carcinoma (BAC) were recently revised, but it is unclear whether these criteria predict clinical behavior. This study determined the outcome of resected BAC in relationship to clinical and radiologic disease pattern, and pathologic features.
Between 1989 and 2000, 100 consecutive surgically treated patients with adenocarcinomas exhibiting various degrees of BAC features were retrospectively studied. Histology was reviewed; tumors were classified as pure BAC, BAC with focal invasion, and adenocarcinoma with BAC features. Clinical and radiologic pattern were classified as unifocal, multifocal, or pneumonic. Demographic data, tumor stage, and outcome were recorded. Survival was analyzed by the Kaplan-Meier method, and prognostic factors were determined by the log-rank test.
Patient median age was 65, and 74% of the patients were female. Pure BAC, BAC with focal invasion, and adenocarcinoma with BAC features occurred in 47, 21, and 32 patients, respectively. Unifocal disease occurred in 64 patients, multifocal in 29, and pneumonic in 7. Seventy-one patients had stage I/II tumors, 22 had stage III/IV, and 7 patients had Stage X tumors. Overall 5-year survival was 74%. There was no significant difference in survival among the three histologic subtypes. The pneumonic pattern had significantly worse survival compared with unifocal and multifocal patterns. Pathologic stage predicted survival, with 5-year survivals for I/II and III/IV of 83.7% and 59.6%, respectively.
Clinical pattern and pathologic stage, but not the degree of invasion on histologic examination predict survival. Multifocal disease is associated with excellent long-term survival after resection. The favorable survival of stage III/IV BAC indicates that the current staging system does not fully describe this disease in patients undergoing resection because of its distinct tumor behavior.
定义细支气管肺泡癌（BAC）的组织学标准最近进行了修订，但尚不清楚这些标准是否能预测临床行为。本研究确定了切除的BAC的预后与临床和放射学疾病模式以及病理特征之间的关系。
对1989年至2000年间连续100例接受手术治疗的腺癌患者进行回顾性研究，这些腺癌具有不同程度的BAC特征。对组织学进行复查；肿瘤分为纯BAC、伴有局灶浸润的BAC以及具有BAC特征的腺癌。临床和放射学模式分为单灶性、多灶性或肺炎型。记录人口统计学数据、肿瘤分期和预后。采用Kaplan-Meier方法分析生存率，并通过对数秩检验确定预后因素。
患者中位年龄为65岁，74%为女性。纯BAC、伴有局灶浸润的BAC以及具有BAC特征的腺癌分别发生在47例、21例和32例患者中。单灶性疾病发生在64例患者中，多灶性在29例中，肺炎型在
