Regnard J F, Santelmo N, Romdhani N, Gharbi N, Bourcereau J, Dulmet E, Levasseur P
Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
Chest. 1998 Jul;114(1):45-50. doi: 10.1378/chest.114.1.45.
To determine the long-term results after surgical treatment of bronchioloalveolar lung carcinoma (BALC) and to identify prognostic factors.
A retrospective study of 70 patients (49 men, 21 women), mean age 61+/-10 years, was carried out. Their carcinomas were classified into three clinicopathologic types: nodular or tumoral, pneumonic, and diffuse types. All the diagnosed BALC cases were reviewed and were classified into histologic types: mucinous, nonmucinous (including fibrotic center), and mixed tumors. Univariate and multivariate analyses were carried out.
The nodular or tumoral type was identified in 42 patients, pneumonic in 21, and diffuse in seven. Histologically, there were 36 mucinous, 25 nonmucinous, and nine mixed tumors. Resection was complete in 61 instances (87%) and incomplete in five. The 5-year survival rate was 34% in patients with curative resections. Five prognostic factors were identified by univariate analysis, but in multivariate analysis, only three factors remained significant: the absence of symptoms, the TNM stage, and completeness of resection. Thirty-six patients with curative resection (59%) developed recurrences (in the lung in 26 patients; mediastinal lymph nodes, four; distant metastases, nine). The frequency of recurrence was significantly greater in patients with pneumonic-type BALC than in nodular or tumoral types (p<0.01), and pulmonary recurrences were significantly more frequent in pneumonic than in tumoral types (p<0.02).
This study confirmed that the overall prognosis of BALC is not significantly different from that of the other non-small cell lung cancers. We found that the lungs are the predominant site of recurrence in BALC, especially in the pneumonic types. The complete surgical resection of localized BALC offers the best chances of long-term survival.
确定细支气管肺泡癌（BALC）手术治疗后的长期结果，并确定预后因素。
对70例患者（49例男性，21例女性）进行了回顾性研究，平均年龄61±10岁。他们的癌症被分为三种临床病理类型：结节状或肿瘤型、肺炎型和弥漫型。对所有诊断为BALC的病例进行回顾并分为组织学类型：黏液性、非黏液性（包括纤维化中心）和混合型肿瘤。进行了单因素和多因素分析。
42例患者为结节状或肿瘤型，21例为肺炎型，7例为弥漫型。组织学上，有36例黏液性肿瘤、25例非黏液性肿瘤和9例混合型肿瘤。61例（87%）切除完整，5例不完整。根治性切除患者的5年生存率为34%。单因素分析确定了5个预后因素，但多因素分析中只有3个因素仍然显著：无症状、TNM分期和切除完整性。36例根治性切除患者（59%）出现复发（26例肺部复发；纵隔淋巴结4例；远处转移9例）。肺炎型BALC患者的复发频率明显高于结节状或肿瘤型（p<0.01），肺炎型肺部复发明显多于肿瘤型（p<0.02）。
本研究证实BALC的总体预后与其他非小细胞肺癌无显著差异。我们发现肺部是BALC复发的主要部位，尤其是肺炎型。局限性BALC的完整手术切除提供了最佳的长期生存机会。
