细支气管肺泡癌52例临床分析

Bronchioloalveolar carcinoma: a retrospective analysis of 52 patients

目的 探讨细支气管肺泡癌 (bronchioloalveolarcarcinoma ,BAC)的临床诊治和预后。方法 对 1990年 4月～ 2 0 0 0年 4月收治并经病理证实的 5 2例BAC患者的资料进行回顾性分析 ,分别对局限型和弥漫型细支气管肺泡癌的临床症状、治疗方法、生存情况做分析研究。结果 分析病例占同期肺部肿瘤的 2 .5 % ,临床症状与肺癌相似 ,弥漫型患者气促或肺部特征明显多于局限型。 47例患者行手术治疗 ,5例行全身化疗。死亡 2 8例 (5 3 .9% ) ,其中死于复发 10例 (19.2 % ) ,转移 18例(34.6 % )。局限型BAC患者中位生存时间为 2 4.3个月 ,弥漫型为 5 .3个月 ,差异有显著性 (P <0 0 5 )。Ⅱ期BAC患者中位生存时间为 2 6 .8个月 ,non BAC腺癌患者为 42 .5个月 ,差异有显著性 (P <0 .0 5 )。BAC组根治术后累计总体生存率与non BAC组以及鳞癌组相比 ,差异无显著性 (P >0 .0 5 ) ,但趋势分析显示 ,生存率依鳞癌组、non BAC组、BAC组的顺序呈下降趋势 (P <0 .0 5 )。结论 局限型BAC较弥漫型预后要好。BAC的生物学特性可能更具恶性倾向 ,与普通腺癌相比 ,术后更需辅助治疗 ,对Ⅱ期的BAC可考虑辅以术后全身化疗或放疗。

Objective To present the treatment and prognosis of bronchioloalveolar carcinoma (BAC).Methods A retrospective study was conducted on 52 bronchioloalveolar carcinoma patients admitted from April 1990 to April 2000 with emphasis on clinical manifestations, treatment and survival. All lesions were pathologically proved as either localized or diffused type.Results These 52 cases comprised 2.5% lung tumors treated in the same period. Its clinical symptoms were similar to those of the other lung cancers. Short of breath and positive physical chest findings were more common in the diffused type. Fourty seventy of these 52 patients underwent surgery and 5, chemotherapy. Follow up showed that 28 (53.8%) patients have died; 10 (19.2%) of recurrence and 18 (34.6%) of metastasis with a median survival of 24.3 months for the localized type and 5.3 months for the diffused type ( P <0.05), The median survival of stage Ⅱ BAC was 26.8 months in contrast of 42.5 months of stage Ⅱ non BAC adenocarcinoma group( P <0.05). However, there was no significant difference in the overall survival rates of BAC and non BAC squamous carcinoma ( P >0.05). Even though, trend analysis still showed that there is a tendency of decline in the survival rates from squamous cancer, non BAC and BAC though ( P < 0.05). Conclusion Localized BAC gives a better prognosis than diffused BAC of which the biological characteristics are different from those of the non BAC. Compared with the non BAC, a more active postoperative treatment should be considered for the BAC patients, such as postoperative chemotherapy and or radiotherapy, especially for stageⅡ BAC lesions.