Daly R C, Trastek V F, Pairolero P C, Murtaugh P A, Huang M S, Allen M S, Colby T V
Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Ann Thorac Surg. 1991 Mar;51(3):368-76; discussion 376-7. doi: 10.1016/0003-4975(91)90847-j.
One hundred thirty-four consecutive patients (65 men and 69 women) underwent pulmonary resection for bronchoalveolar carcinoma. Mean age was 65 years. Lobectomy was done in 100 patients, pneumonectomy in 10, segmentectomy in 5, and wedge excision in 19. Only 10 patients had lymph node metastases (7.5%). The neoplasm was solitary in 111 patients (82.8%); 97 were in stage I, 4 were in stage II, 9 were in stage IIIa, and 1 was in stage IIIb. There were two operative deaths (1.5%). Thirty-nine complications occurred in 31 patients. Median follow-up was 5.1 years. Recurrent bronchoalveolar carcinoma developed in 45 patients. Five- and 10-year survival for patients in stage I was 75.2% and 62.0%, respectively. Survival for patients with T1 N0 M0 neoplasms was identical to expected survival and was 90.5% at 5 years, as compared with 55.4% for patients with T2 N0 M0 disease, only 35.9% for patients with multiple bilateral disease, and 0.0% for patients with bilateral disease (p less than 0.0001). Other significant factors adversely affecting survival included the presence of signs and symptoms, diffuse malignant invasion, mucin-producing tumors, and the histological absence of scar. We conclude that bronchoalveolar carcinoma has a unique natural history that is more influenced by local neoplastic processes than by lymph node metastases. Early aggressive pulmonary resection is safe and offers the potential for cure. The presence of bilateral cancer, however, is ominous.
134例连续患者（65例男性和69例女性）接受了支气管肺泡癌肺切除术。平均年龄为65岁。100例行肺叶切除术，10例行全肺切除术，5例行肺段切除术，19例行楔形切除术。仅10例患者有淋巴结转移（7.5%）。肿瘤为孤立性的有111例患者（82.8%）；97例为Ⅰ期，4例为Ⅱ期，9例为Ⅲa期，1例为Ⅲb期。有2例手术死亡（1.5%）。31例患者发生了39例并发症。中位随访时间为5.1年。45例患者出现复发性支气管肺泡癌。Ⅰ期患者的5年和10年生存率分别为75.2%和62.0%。T1 N0 M0肿瘤患者的生存率与预期生存率相同，5年生存率为90.5%，而T2 N0 M0疾病患者为55.4%，双侧多发疾病患者仅为35.9%，双侧疾病患者为0.0%（p<0.0001）。其他对生存有不利影响的重要因素包括体征和症状的存在、弥漫性恶性浸润、黏液生成肿瘤以及组织学上无瘢痕。我们得出结论，支气管肺泡癌有独特的自然病史，其受局部肿瘤进程的影响大于淋巴结转移。早期积极的肺切除术是安全的，并提供了治愈的可能性。然而，双侧癌的存在是不祥之兆。
