细支气管肺泡癌：发病率、外科治疗与生存率

Bronchioloalveolar lung cancer: occurrence, surgical treatment and survival.

作者信息

Furák József, Troján Imre, Szoke Tamás, Tiszlavicz László, Morvay Zita, Eller József, Balogh Adám

机构信息

Department of Surgery, University of Szeged, Szeged, Hungary.

出版信息

Eur J Cardiothorac Surg. 2003 May;23(5):818-23. doi: 10.1016/s1010-7940(03)00084-8.

DOI:10.1016/s1010-7940(03)00084-8

PMID:12754039

Abstract

OBJECTIVE

The prevalence of pulmonary adenocarcinoma has risen worldwide. Bronchioloalveolar carcinoma (BAC) was studied with regard to whether it exhibits a similar tendency, and its typical features were analysed.

METHODS

Between 1992 and 2001, 278 lung resections were carried out for adenocarcinoma. Of these, 67 (24.1%) proved to involve BAC. Whereas BAC accounted for 6.9% of the cases in 1992, in 2001 the proportion was 46.9%. There were 37 men (55.2%) and 30 women (44.7%); the average age was 60.5 years. 58.2% of them had no complaints. Of the 26 non-smokers, 69.2% were women; of the 41 smokers, 29.2% were women. In consequence of the tumour, 49 lobectomies, three bilobectomies, six pneumonectomies and nine wedge resections were performed.

RESULTS

The surgical mortality was 1.6%. The pathology revealed that 26 (38.8%) tumours were in stage I/A. In 15 cases (22.4%), tuberculosis (TB) could be revealed besides the BAC: by skin tests in four cases, by CT in three cases, by case history in four cases, and by pathology in four cases. For the overall group of 67 patients, the 5-year survival rate was 61.9%, and the mean survival time was 75.7 months. The 5-year survival rate among the women (74%) was significantly better than that among the men (37%) (P=0.030). There was no significant difference in survival with regard to the multiple BAC (85%). The 5-year survival rate was significantly worse in the mixed BAC group (20%) than in the non-mucinous (62.7%) and in mucinous (59%) group. The overall 5-year survival rate among the smokers and TB patients was 61 and 79%, respectively, which is higher than that among the non-smokers (47%) and non-TB patients (56%). The survival rate for the wedge resection cases was 37%, which was lower than that for the cases involving major resections (60%) (P=0.939).

CONCLUSION

BAC has a favourable survival, particularly in women. In spite of this, resection smaller than lobectomy is recommended only as a compromise. A multiple appearance does not imply a worse survival. The best survival rate was found in the non-mucinous BAC among the histological groups. TB seems to be frequent among BAC patients.

摘要

目的

全球范围内肺腺癌的患病率呈上升趋势。对细支气管肺泡癌（BAC）是否呈现类似趋势进行研究，并分析其典型特征。

方法

1992年至2001年间，对278例因腺癌行肺切除术的患者进行研究。其中，67例（24.1%）证实为BAC。1992年BAC占病例的6.9%，而2001年这一比例为46.9%。患者中男性37例（55.2%），女性30例（44.7%）；平均年龄60.5岁。58.2%的患者无不适症状。26例不吸烟者中，69.2%为女性；41例吸烟者中，29.2%为女性。因肿瘤行肺叶切除术49例、双肺叶切除术3例、全肺切除术6例及楔形切除术9例。

结果

手术死亡率为1.6%。病理显示，26例（38.8%）肿瘤处于I/A期。15例（22.4%）患者除BAC外还发现有肺结核（TB）：4例通过皮肤试验发现，3例通过CT发现，4例通过病史发现，4例通过病理发现。67例患者总体5年生存率为61.9%，平均生存时间为75.7个月。女性5年生存率（74%）显著高于男性（37%）（P = 0.030）。多灶性BAC患者的生存率无显著差异（85%）。混合性BAC组的5年生存率（20%）显著低于非黏液性组（62.7%）和黏液性组（59%）。吸烟者和TB患者的总体5年生存率分别为61%和79%，高于不吸烟者（47%）和非TB患者（56%）。楔形切除术患者的生存率为37%，低于行大手术患者的生存率（60%）（P = 0.939）。