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目的:探讨细支气管肺泡癌(BAC)及具有细支气管肺泡癌特征的混合型腺癌的临床特点、组织学特性、治疗模式及预后因素。方法:对71例可手术的BAC及具有BAC特征的腺癌患者的资料进行回顾性分析,探讨BAC及具有BAC特征的腺癌患者的临床表现、治疗模式和影响预后的因素。结果:有症状者主要表现为咳嗽、咳痰、胸痛、痰血、胸闷气急和声嘶,症状无明显的特异性。治疗模式为单手术治疗45例(63.4%),手术+术后辅助化疗20例(28.2%),手术+术后辅助放化疗5例(7.0%),手术+术后辅助放疗1例(1.4%)。总体1、3和5年生存率分别为90.0%、77.0%和64.0%。Ⅰ+Ⅱ期与Ⅲ+Ⅳ期患者术后五年生存率分别为69.7%和21.4%(P<0.05),单纯BAC、BAC伴局部浸润、有BAC特征的混合型腺癌5年生存率分别为91.7%、76.9%和54.6%。肿瘤直径≤3cm组5年生存率和中位生存期均高于肿瘤直径>3cm组,P值均<0.05。患者无淋巴结转移组(N0)与有淋巴结转移组(N1+N2)中位生存期差异有统计学意义,P=0.008。结论:细支气管肺泡癌症状无明显的特异性,早期可无症状。手术为首选治疗方法,术后辅助化疗、辅助放疗患者未见生存获益。肿瘤大小、有无淋巴结转移、TNM分期、是否单纯型BAC是影响预后的因素。
Objective: To investigate the clinical features, histological characteristics, treatment modalities and prognostic factors of bronchioalveolar carcinoma (BAC) and mixed adenocarcinoma with bronchioloalveolar carcinoma. Methods: The data of 71 patients with operable BAC and adenocarcinoma with BAC features were analyzed retrospectively to investigate the clinical manifestations, treatment modalities and prognostic factors of BAC and adenocarcinoma with BAC features. Results: The main symptoms of cough, sputum, chest pain, sputum blood, chest tightness and hysterical hoarseness, symptoms no obvious specificity. There were 45 cases (63.4%) treated by single operation, 20 cases (28.2%) treated by surgery plus adjuvant chemotherapy, 5 cases treated by adjuvant radiotherapy and chemotherapy after operation (7.0%) and one case treated by postoperative adjuvant radiotherapy %). Overall 1,3 and 5 year survival rates were 90.0%, 77.0% and 64.0%, respectively. The five-year survival rates of patients with stage Ⅰ + Ⅱ and stage Ⅲ + Ⅳ postoperation were 69.7% and 21.4% respectively (P <0.05). The 5-year survival rates of mixed adenocarcinoma with BAC, BAC with local infiltration and BAC were 91.7%, 76.9% and 54.6% respectively. The 5-year survival rate and median survival time of tumor diameter ≤3cm group were higher than those of tumor diameter> 3cm group (P <0.05). There was a significant difference in median survival between patients without lymph node metastasis (N0) and those with lymph node metastasis (N1 + N2), P = 0.008. Conclusion: The symptoms of bronchioloalveolar carcinoma have no obvious specificity and can be asymptomatic early. Surgery as the preferred treatment, postoperative adjuvant chemotherapy, adjuvant radiotherapy in patients with no survival benefit. Tumor size, with or without lymph node metastasis, TNM staging, whether simple BAC is a prognostic factor.