细支气管肺泡癌52例临床分析

目的 探讨细支气管肺泡癌（bronchinloalveolar carcinoma,BAC)的临床诊治和预后。方法 对1990年4月－2000年4月收治并经病理证实的5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28例（53．9％），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24．3个月，弥漫型为5．3个月，差异有显著性（P＜0．05）。Ⅱ期BAC患者中位生存时间为26．8个月，non-BAC腺癌患者为42．5个月，差异有显著性（P＜0．05）。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＞0．05），但趋势分析显示、生存率依鳞癌组、non-BAC组的顺序呈下降趋势（P＜0．05）。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。

Bronchioloalveolar carcinoma: a retrospective analysis of 52 patients

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. Forty-seven 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 stage II BAC lesions.