Ⅰ期支气管肺泡细胞癌与肺腺癌外科治疗

A retrospective study of surgical treatment for stage I pure bronchioloalveolar carcinoma comparison with adenocarci-noma of the lung

目的比较外科手术治疗的Ⅰ期支气管肺泡细胞癌与同分期肺腺癌在流行病学特点、临床表现、影像学特点、手术疗效以及复发转移方面的差异。方法选取“肺叶切除手术病例登记统计系统”数据库收集的2006年9月至2011年12月北京大学人民医院胸外科完成的全部Ⅰ期支气管肺泡细胞癌手术病例，与同期同手术方法完成的Ⅰ期肺腺癌病例进行回顾性对比研究。结果排除病理诊断中支气管肺泡细胞癌与腺癌混杂病例，研究共纳入337例，其中支气管肺泡细胞癌39例，肺腺癌298例。两组比较前者女性多见（69．2％对52．0％，P=0．042），年龄年轻（57．4岁对61．8岁，P=0．014），吸烟者比例较低（12．8％对29．9％，P=0．026）；胸部CT上表现为磨玻璃样病变者多（35．9％对9．7％，P〈0．001），肿瘤直径小（1．4cm对2．3cm，P〈0．001）；但在手术方式（全胸腔镜肺叶切除92．3％对95．0％，P=0．752）、于术时间（182．8min对182．4min，P=0．973）、术中出血量（188．2ml对177．1ml，P=0．700）和并发症发生率（2．6％对14．1％，P=0．076）方面两组无差异；3年无瘤生存率（100％对76．1％，P=0．030）和总生存率（100％对86．1％，P=0．041），Kaplan-Meier生存曲线显示支气管肺泡细胞癌患者均优于肺腺癌患者。结论Ⅰ期支气管肺泡细胞癌与同分期肺腺癌相比在流行病学特点、临床表现、影像学特点和复发转移方式方面均具有特殊性，胸腔镜肺叶切除加系统淋巴结清扫是其首选合理手术方式，手术治疗预后良好。

Objective To analyse the difference between stage I pure bronchioloalveolar carcinoma （BAC） and stage I adenocarcinoma of the hmg among operative cases. Methods We use the ＂Lobectomy Cases Registration and Statistics Sys- tem＂ database （2006-2011） to compare the epidemiology, clinical presentation, image characteristics, surgical outcomes, recurrence and overall survival between BAC and adenoearcinoma groups. All the patients received lobectomy procedure in the department of thoracic surgery of Peking University People＇ s Hospital. Results Excluding those cases with both BAC and ad- enocareinoma aspects, 337 patients were enrolled. Thirty-nine patients were stage [ pure BAC and 298 patients were stage l adenocareinoma. BAC has its proper clinical spectrum, occurring more frequently in women （69.2% vs. 52.0% , P =0. 042） and in younger patients （57.4 vs. 61.8, P =0. 014）. BAC also seems to be less dependent on tobacco exposure （ 12.8% vs. 29.9% , P =0. 026）. The percentage of ground-glass opacity （GGO） in CT scan of BAC patients was much more than that registered in adenacareinoma patients （ 35.9% vs. 9.7% , P 〈 0. 001 ）. And the tumor size of BAC group was smaller than that of the adenocarcinoma group （ 1.4 cm vs. 2.3 era, P 〈0. 001 ）. The operation method,time,blood loss and complications were similar between the two groups. Kaplan-Meier survival curves showed that both 3-year disease-free survival （DFS） and overall survival （OS） were significantly higher in patients affected by BAC （100% vs. 76.1% , P =0. 030 and 100% vs. 86.1% , P =0. 041 ）. Conclusion BAC presents specificity in its epidemical,clinical, radiological and evolutionary aspects. Stage [ pure BAC patients have better prognosis following video-assisted thoracoscopie ]obectomy and system lymph node dissection than the similar stage adenocareinoma patients.