Prognosis and recurrent patterns in bronchioloalveolar carcinoma

Study objective: Bronchioloalveolar carcinoma (BAC) is an uncommon pulmonar y neoplasm with various radiologic and clinical presentations. In this arti cle, we analyze the initial radiologic findings, TNM stagings, surgical typ es, and radiologic features of recurrence, and correlate them with patient survival. Design: A retrospective review of 93 patients who under-went resection for BAC from February 1989 to May 1999. Patients: There were a total of 153 patients with BAC diagnosed during this period. Among them, 60 patients (39.2%) had diffuse disease and received m edical therapy only, and the remaining 93 patients (60.8%), who had localiz ed disease, underwent surgical resection. Patients who received surgical re section were enrolled in this study. Measurements: Data regarding demographics, presentation symptoms, initial r adiologic features, surgical type, tumor staging, recurrence status, radiol ogic patterns of recurrence, and survival were obtained from all patients. Results: Female patients were significantly younger than male patients. Pat ients who were female, nonsmoking, undergoing curative surgery, lobectomy, or bilobectomy, and with early tumor staging and no nodal involvement had a better prognosis. Patients with a right lung tumor had a longer survival t han those with a left lung tumor, with borderline significance. Among those who suffered from recurrent diseases, a second resection yielded a better survival. Multivariate analysis showed curative surgery, initial surgical t ype, recurrence status, radiologic patterns of recurrence, and duration fro m surgical resection to recurrence all had a significant impact on survival . Conclusions: Those patients with localized, early-stage BAC who underwent c urative surgery had a better survival. Patients with localized recurrence a fter the initial surgery wall-anted a second resection. Those with a diffus e radiologic pattern of recurrence and/or early recurrence had a worse prog nosis.