130例细支气管肺泡癌外科治疗疗效分析

Surgical Treatment Efficacy of Bronchioloalveolar Carcinoma:A Retrospective Analysis of 130 Patients

背景与目的:细支气管肺泡癌(bronchioloalveolarcarcinoma,BAC)是一种外周型的、分化较好的、沿着肺泡间隔生长而不浸润肺间质的、特殊类型的肺腺癌。对于BAC的外科治疗以及其疗效一直存在着争议。本研究探讨BAC的外科治疗以及其疗效。方法:收集1985～2000年本院收治的术后病理诊断的BAC130例,分析BAC的临床特点、组织学特性,回顾不同TNM分期和临床分型BAC的外科治疗与疗效。结果:本组男性发病率56.9%,女性发病率43.1%,中位年龄58岁,吸烟者与不吸烟者之比为1∶1.55。全组行根治性手术98例,姑息性和探查手术32例,其中Ⅰ期54例、Ⅱ期15例均行根治性切除,ⅢB期11例、Ⅳ期19例,根治性切除ⅢB期2例、Ⅳ期1例,Ⅰ、Ⅱ、ⅢB、Ⅳ期5年生存率分别为60.7%,33.3%,13.6%和14.0%;孤立结节型113例,多发结节型12例和肺炎型5例,根治性切除分别为96例、1例和1例,中位生存时间为46.3、20.6和5个月,1、3、5年生存率:孤立结节型96.4%,58.6%和41.2%,多发结节型91.2%,41.7%和33.3%,肺炎型20.0%,0和0。结论:Ⅰ、Ⅱ期和ⅢB、Ⅳ期多发结节型BAC,采用手术根治性切除预后较好,肺炎型BAC,预后较差。

BACKGROUND ＆ OBJECTIVE- Bronchioloalveolar carcinoma （BAC） is a well-differentiated lung adenocarcinoma occurring in the periphery of the lung and growing along an intact interstitial framework. There are controversies about the surgical treatment efficacy of BAC. This study was to explore the surgical treatment efficacy of BAC. METHODS： Data were collected from 130 patients with BAC, hospitalized in the department of Thoracic Surgery, Cancer Center of Sun Yat-sen University, diagnosed by postoperative pathology from 1985 to 2000. Clinical and histological features, approaches and outcomes of surgical treatment according to different TNM stages and clinical patterns were studied retrospectively. RESULTS： Of the 130 patients, 56.1% were men, 42.9% were women. The ratio of smoker to non-smoker was 1：1.55. Ninety-eight patients underwent complete resection and 32 underwent incomplete resection. Patients in stage I （n=54）, stage Ⅱ （n=15）, stage Ⅲ B （2/11 ）, and stage Ⅳ （1/19） underwent complete resection, of whom the 5-year survival rates were 60.7%, 33.3%, 13.6%, and 14.0%, respectively. Patients of unifocal （96/113）, multifocal （1/12）, and pneumonic （1/19） patterns underwent complete resection,of whom the median survival time was 46.3, 20.6, and 5 months. The 1-, 3-, and 5-year survival rates were 96.4%, 58.6%, and 41.2% for the unifocal pattern, 91.2%, 41.7%, and 33.3% for the multifocal pattern, 20%, 0, and 0 for the pneumonic pattern. CONCLUSION： Complete surgical resection can achieve favorable survival rates for BAC in stage Ⅰ /Ⅱ and multifocal BAC in stage Ⅲ/Ⅳ, whereas relatively poorer prognosis for pneumonic BAC.