Section of Thoracic Surgery, Department of Epidemiology, Yale University School of Public Health, New Haven, Connecticut 06520-8062, USA.
Ann Thorac Surg. 2012 Sep;94(3):935-40; discussion 940-1. doi: 10.1016/j.athoracsur.2012.04.069. Epub 2012 Jul 25.
Advanced bronchoalveolar carcinoma (BAC) carries a poor prognosis, with median survival of approximately 1 year. More extended survivals have been reported after lung transplantation for BAC; however, fewer than 50 patients have been reported. To compare outcomes of lung transplantation for advanced BAC, we studied this population in a compulsory, prospectively maintained database.
The United Network for Organ Sharing (UNOS) database was queried for patients undergoing lung transplant from 1987 to 2010 for the diagnosis of BAC or cancer. Pathology reports of explanted specimens were reviewed.
Twenty-nine patients underwent lung transplantation for BAC, representing 0.13% of the 21,553 lung transplants during the study period. BAC patients had better forced expiratory volume in 1 second percent predicted (60% vs 35%, p<0.0001) and received more double-lung transplants (79% vs 54%, p=0.006). Pure BAC was present in only 52% of the explants, whereas 41% had some degree of invasive tumor, and 7% had pure adenocarcinoma. The BAC and general lung transplantation cohorts had similar 30-day mortality (10% vs 7%, p=0.44) and 5-year survival (57% vs 50%, p=0.66).
Survival after lung transplantation for BAC appears to be consistent with that of lung transplantation for other diagnoses and is better than that reported with chemotherapy. Further study is warranted to identify the subgroup of patients with lung cancer who will have a maximum survival advantage after lung transplantation.
高级支气管肺泡癌（BAC）预后不良，中位生存期约为 1 年。有报道称，肺移植后 BAC 的存活时间更长；然而，报告的病例少于 50 例。为了比较肺移植治疗晚期 BAC 的结果，我们在一个强制性的、前瞻性维护的数据库中研究了这一人群。
从 1987 年到 2010 年，美国器官共享联合网络（UNOS）数据库对诊断为 BAC 或癌症的患者进行了肺移植查询。对移植标本的病理报告进行了回顾。
29 例患者因 BAC 接受了肺移植，占研究期间 21553 例肺移植的 0.13%。BAC 患者的 1 秒用力呼气量预测值（60%比 35%，p<0.0001）更好，且接受双肺移植的比例更高（79%比 54%，p=0.006）。仅有 52%的标本为单纯 BAC，而 41%有一定程度的侵袭性肿瘤，7%为单纯腺癌。BAC 和普通肺移植两组的 30 天死亡率（10%比 7%，p=0.44）和 5 年生存率（57%比 50%，p=0.66）相似。
肺移植治疗 BAC 的存活率似乎与其他诊断的肺移植存活率一致，且优于化疗报告的存活率。需要进一步研究以确定哪些肺癌患者在接受肺移植后将获得最大的生存优势。
