Harpole D H, Bigelow C, Young W G, Wolfe W G, Sabiston D C
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Ann Thorac Surg. 1988 Nov;46(5):502-7. doi: 10.1016/s0003-4975(10)64685-1.
From 1970 to 1986, survival of 205 patients with alveolar cell carcinoma was retrospectively studied. Analysis examined the predictive value of presenting symptoms and diagnostic screening results for pathological Stage III or IV disease (advanced) and survival. The lesion presented as a peripheral mass in 121 patients (59%) and as an infiltrate in 84 (41%). Follow-up data were available on 199 patients (97%). Variables analyzed included indices of background or risk factors, presenting symptoms, diagnostic test results, and clinical management. Seventy-nine patients (39%) had a histological diagnosis of advanced disease by TMN staging criteria. Of the 152 deaths (74%), 117 (77%) were related to the pulmonary carcinoma. Univariate analysis associated short-term and long-term anorexia, weight loss, generalized weakness, and profound dyspnea with advanced disease and ultimately with death due to cancer. Multivariate logistic regression analyses suggested that weight loss and dyspnea disclosed independent information about the likelihood of advanced disease for this population (p less than 0.0003). Cox proportional hazard regression analyses of survival revealed a significant association between weight loss and death due to alveolar cell carcinoma after pathological stage was taken into account (p = 0.001). In this series, the 80 patients with Stage I disease had the best prognosis (5-year survival of 55%). There was no significant difference in disease-free survival between patients having wedge resection (N = 17) and those having lobectomy (N = 63) for Stage I disease.
1970年至1986年，对205例肺泡细胞癌患者的生存情况进行了回顾性研究。分析探讨了出现的症状和诊断筛查结果对病理Ⅲ期或Ⅳ期疾病（晚期）及生存的预测价值。121例患者（59%）的病变表现为周围型肿块，84例（41%）表现为浸润性病变。199例患者（97%）有随访数据。分析的变量包括背景或危险因素指标、出现的症状、诊断检查结果及临床处理情况。根据TMN分期标准，79例患者（39%）组织学诊断为晚期疾病。在152例死亡患者中（74%），117例（77%）与肺癌有关。单因素分析显示，短期和长期食欲不振、体重减轻、全身乏力及严重呼吸困难与晚期疾病相关，并最终与癌症死亡相关。多因素逻辑回归分析表明，体重减轻和呼吸困难为该人群晚期疾病可能性提供了独立信息（p<0.0003）。生存情况的Cox比例风险回归分析显示，在考虑病理分期后，体重减轻与肺泡细胞癌死亡之间存在显著关联（p = 0.001）。在本系列研究中，80例Ⅰ期疾病患者预后最佳（5年生存率为55%）。Ⅰ期疾病患者行楔形切除术（n = 17）和肺叶切除术（n = 63）后的无病生存率无显著差异。
