细支气管肺泡癌的系统治疗进展

Advances in the systemic management of bronchioloalveolar cell carcinoma

WHO定义的细支气管肺泡癌(BAC)为非小细胞肺癌(NSCLC)的一个不常见亚型。但是,若将腺癌伴BAC特征和BAC伴局灶浸润性腺癌等混合型肿瘤包括在内,BAC在腺癌中构成了相当比例,表现出与不含BAC特征的腺癌迥异的行为,其独特的流行病学、病理学、放射学特征、临床特点、自然史以及对表皮生长因子受体酪氨酸激酶抑制剂(EG FR-TKI)和可能的其他靶向治疗的特殊敏感性正吸引着越来越多的研究者的目光。目前的资料虽然不足以确定BAC对化疗的敏感性与其他NSCLC有区别,但其对EGFR-TKI的独特敏感性却提示对所有NSCLC的精确组织学分类,特别是在当今靶向治疗时代是非常必要的。本文综述近年来BAC系统治疗(包括化疗和靶向治疗)临床试验的最新进展,希望对指导目前BAC的治疗和确定未来BAC治疗试验及其研究方向能有所帮助。

Bronchioloalveolar cell carcinoma （BAC）, as defined by WHO, is a relatively uncommon subtype of non - small - cell lung cancer （NSCLC）. However, when such mixed tumors as adenocarcinoma with BAC features and BAC with focal invasion are included, BAC makes up a considerably high percentage of adenocarcinomas and appears to behave quite differently than those without BAC features. More and more researchers have been fascinated by its unique epidemiology, pathology, radiology, clinical features, natural history, and the specific sensitivity to the epidermal growth factor receptor tyrosine kinase inhibitors （EGFR- TKIs） and possibly other targeted therapies. Although current data are insufficient to confirm whether the sensitivity of BAC to chemotherapy is different from that of other NSCLCs, the distinctive sensitivity of BAC to EGFR - TKIs suggests that a precise histology classification of all NSCLCs is quite necessary, particularly in this era of targeted therapy. Here we review the recent advances in the clinical trials of systemic management of BAC, including chemotherapy and targeted therapy.