具有细支气管肺泡癌特征肺腺癌的临床病理分析

目的 进一步了解严格定义的细支气管肺泡癌(BAC)、伴有BAC成分腺癌的比例及预后情况,以及各组织学亚型腺癌的发生率.方法 收集1998-2005年间外科手术治疗病理诊断为肺原发腺癌的病例共348例.按照2004版WHO肺肿瘤分类标准对所有组织学切片进行复习和分类,同时进行临床资料收集,并重点对纯BAC、BAC形态为主伴有局灶浸润的病例、腺癌伴有BAC成分等3组病例进行了随访.结果 纯BAC占腺癌病例的3.7%(13/348),而伴有BAC成分的腺癌则占了31.3%(109/348).大部分切除的肺腺癌都是由不同组织学亚型混合构成,混合亚型所占的比例为78.2%(272/348),混合亚型中的构成成分以腺泡样最为多见(88.2%),其次是BAC(40.1%)、乳头状(24.6%)、实性型(16.9%)等.最少见的构成成分是胎儿型腺癌样结构.对纯BAC病例、BAC形态为主伴有局灶浸润、腺癌伴有BAC成分3组病例的随访发现.前两组患者的生存时间均较长,两者总体生存率没有显著性差异,但是伴有局灶浸润的患者有部分在随访期间出现了进展;而腺癌伴有BAC成分组的病例总体生存率比前两组要差.结论 单纯的BAC、BAC形态为主伴有局灶浸润、腺癌伴有BAC形态的混合亚型具有独特的预后预测作用,而且在临床治疗中对生物靶治疗具有独特反应性,应将其区分开,为临床提供可靠的治疗依据.

Clinicopathologic study of pulmonary adenocarcinoma with features of bronchioloalveolar carcinoma

Objective Further investigation on the incidence and clinicopathologic features of bronchioloalveolar carcinomas (BAC) including: (1) BAC of strictly defined, (2) adenocarcinoma with bronchioloalveolar features, (3) other different histologic subtypes of lung adenocarcinomas. Methods Surgical specimens from 348 lung adenocarcinoma patients admitted in that hospital between 1998 - 2005 were included. And clinical data were collected at the same time. Patients of strictly defined BAC, BAC with focal invasion ( BWFI), and adenomas with bronchioloalveolar features (AWBF) were followed-up. Data were analyzed using SPSS statistics software and Kaplan-Meier survival curves were constructed. Resuls The resected lung adenocarcinomas consisted of different histologic subtypes. The most frequent one was adenocarcinoma of mixed subtypes (78.2% ,272/348 ), followed by the acinar type (8.1% ,25/348 ), the papillary type (4.0%, 14/348 ), the BAC ( 3.7%, 13/348 ), the mncinous ( colloid ) type ( 3.4%, 12/348) and the solid types (2.3% ,8/348). The fetal adenocarcinoma was the least component detected. There was no significant difference on the survival curves between groups BAC and BWFI. The survival rate of patients with AWBF was poorer than that of BAC and BWFI. Conclusions Since patients with strictly defined (simple) BAC, BWFI, and AWBF have their own distinct clinicopathologic features and prognosis respectively, they should be strictly distinguished from other types of pulmonary adenocarcinomas.