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University of Torino Department of Thoracic Surgery, Castellamonte, Italy
PURPOSE: To assess prognostic factors in patients operated on for bronchiolalveolar carcinoma (BAC) of the lung.
METHODS: Between 1993 and 2000, 108 patients underwent pulmonary resection for BAC. There were 68 male (63%) and 40 female, mean age 63.8 years (range 29-77 years). Seventy-eight BACs (72.3%) were in the upper pulmonary lobes. Ninety-two lobectomies (85.2%) (69 upper), 7 pneumonectomies and 9 wedge-resections were carried out, and radical lymphadenectomy was always performed.
RESULTS: Fifty-one tumors were less than 3 cm and 57 (52.8%) more than 3 cm in size. BACs resulted well- or middle-differentiated in 98 cases (91%). Microvascular, perineural and visceral pleural invasion were evident in 38, 6 and 26 cases respectively. Seventy-four tumours (68.5%) were at stage I, 10 at stage II, 22 at stage IIIa and 2 at stage IIIb. Three, 5 and 10 year survival rates were 66%, 63% and 55%, respectively.No survival differences were observed for age, gender, tumor grading, tumor size and visceral pleural involvement. Significant prognostic factors were microvascular invasion (p=0.01), perineural invasion (p=0.04), nodal status (p=0.007) and pathological staging (p=0.008).
CONCLUSION: BACs show a better survival than others NSCLC, when radically resected. Microvascular and perineural invasions, nodal status and staging are significant factors in predicting long-term survival.
CLINICAL IMPLICATIONS: an early stage BAC has a favourable long-term survival. A solitary pulmonary nodule in high risk patient, should be considered as a possible BAC. Early diagnosis and surgical treatment are thus mandatory.
DISCLOSURE: Pier Luigi Filosso, None.
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