BRONCHOALVEOLAR CARCINOMA - HISTOPATHOLOGIC STUDY OF EVOLUTION IN A SERIES OF 105 SURGICALLY TREATED PATIENTS

Study objective: The clinical characteristics, histopathologic conditi on, and outcome of bronchoalveolar carcinoma (BAC) were studied to det ect possible prognostic indicators. Design: A retrospective review was conducted of 97 patients who had a curative resection for BAC between 1975 and 1993. Patients: There were 83 men and 14 women with a mean a ge of 59 years (30 to 75 years). Interventions: Resection comprised lo bectomy in 84 cases (87%), bilobectomy, pneumonectomy, and a wedge exc ision. Results: Sixty-two percent of patients were asymptomatic, The r adiographic pattern was a solitary nodule in 85% of patients and lobar pneumonitis or diffuse infiltrate in 15%, In 12% of patients, the sol itary lesion had been stable for period of 2 to 7 years before diagnos is, The TNM staging of the disease included 71 patients with stage I, 14 with stage II, and 12 with stage IIIA, Review of the gross patholog ic features revealed web-circumscribed tumors in 88% of patients and d iffuse or multifocal tumors in 12%. Mucinous differentiation was prese nt in 43% of patients, vascular invasion in 22%, and aerogenous spread in 49%. Overall survival was 89% at 1 year, 76% at 2 years, 48% at 5 years, and 39% at 10 years. The survival curves according to histologi c features showed a statistically significant difference between diffu se lesions and nodular lesions, between lesions with and without aerog enous spread (diffuse lesions excluded), and between lesions with and without vascular invasion. Conclusions: The natural history of BAC is especially influenced by its nodular or diffuse nature, vascular invas ion, and aerogenous spread.