细支气管肺泡癌及具有BAC特征腺癌的临床分析

Clinical analysis of bronchioloalveolar carcinoma and adenocarcinoma with BAC features

目的:探讨细支气管肺泡癌(BAC)及具有细支气管肺泡癌特征的混合型腺癌的临床特点、组织学特性、治疗模式及预后因素。方法:对71例可手术的BAC及具有BAC特征的腺癌患者的资料进行回顾性分析,探讨BAC及具有BAC特征的腺癌患者的临床表现、治疗模式和影响预后的因素。结果:有症状者主要表现为咳嗽、咳痰、胸痛、痰血、胸闷气急和声嘶,症状无明显的特异性。治疗模式为单手术治疗45例(63.4%),手术+术后辅助化疗20例(28.2%),手术+术后辅助放化疗5例(7.0%),手术+术后辅助放疗1例(1.4%)。总体1、3和5年生存率分别为90.0%、77.0%和64.0%。Ⅰ+Ⅱ期与Ⅲ+Ⅳ期患者术后五年生存率分别为69.7%和21.4%(P<0.05),单纯BAC、BAC伴局部浸润、有BAC特征的混合型腺癌5年生存率分别为91.7%、76.9%和54.6%。肿瘤直径≤3cm组5年生存率和中位生存期均高于肿瘤直径>3cm组,P值均<0.05。患者无淋巴结转移组(N0)与有淋巴结转移组(N1+N2)中位生存期差异有统计学意义,P=0.008。结论:细支气管肺泡癌症状无明显的特异性,早期可无症状。手术为首选治疗方法,术后辅助化疗、辅助放疗患者未见生存获益。肿瘤大小、有无淋巴结转移、TNM分期、是否单纯型BAC是影响预后的因素。

OBJECTIVE：To investigate the clinical features,tissue characteristics,treatment modes and prognoses of bronchioloalveolar carcinoma （BAC） and adenocarcinoma with BAC features.METHODS：The clinical data of 71 cases who were underwent operations and diagnosed BAC or adenocarcinoma with BAC features were analyzed.RESULTS：The common symptoms were cough,expectoration,chest pain,haemoptysis,dyspnea and trachyphonia,those were no specific.Patients that had accepted only surgical therapy were 45 cases （63.4%）,surgical therapy with adjuvant chemotherapy were 20 cases（28.2%）,with adjuvant chemo and radiotherapy were 5 cases（7.0%） and with adjuvant radiotherapy was 1 case （1.4%）.The overall 1,3 and 5-year survival rates were 90.0%,77.0% and 64.0% respectively.The 5-year survival rates of patients in stage Ⅰ＋Ⅱ and stage Ⅲ＋Ⅳ were 69.7% and 21.4% respectively（P〈0.05）.The 5-year survival rates of Pure BAC,BAC with regional sokage and adenocarcinoma with BAC features were 91.7%,76.9% and 54.6% respectively.The 5-year survival rates of whose tumor size ≤3 cm were higher than those tumor size 〉3 cm （P〈0.05）.The median survival time was much longer in patients without lymph node metatasis than those with lymph node metatasis（P=0.008）.CONCLUSIONS：There are no specific symptoms in BAC and that can be asymptomatic at the early stage.Surgical therapy is the preferred treatment,adjuvant chemotherapy and radiotherapy post operation is unrelated to survival respectively.The size of tumor,N staging,TNM staging,the pathology of BAC are important prognoses factors.