Prognostic value of bronchiolo-alveolar carcinoma component of small lung adenocarcinoma

doi:10.1016/S0003-4975(99)01064-4

The Annals of Thoracic Surgery

Volume 68, Issue 6, December 1999, Pages 2069-2073

https://doi.org/10.1016/S0003-4975(99)01064-4 Get rights and content

Abstract

Background. Bronchiolo-alveolar carcinoma (BAC) is often observed in lung adenocarcinoma, but its clinicopathological and prognostic significance, especially in small peripheral lung adenocarcinoma, remains undetermined.

Methods. We assessed 206 consecutive cases of surgically resected small peripheral lung adenocarcinoma (less than 2 cm in diameter) recorded between 1973 and 1997. According to the component area of well differentiated BAC within maximally cut surface specimens of tumor tissue, we semiquantitatively classified the tumors into four types: those in which the BAC component comprised 0% (type I), 1% to 49% (type II), 50% to 99% (type III), and 100% (type IV) of the tumor tissue.

Results. Forty tumors were classified as type I, 75 as type II, 74 as type III, and 17 as type IV. The tumors with less BAC, especially type I and II, showed a significantly more aggressive nodal involvement and tumor stage, and consequently a worse prognosis, while type IV tumors had no nodal involvement and the most favorable prognosis. The patients with type III showed clinicopathological characteristics somewhere between those of type II and type IV patients. Among stage I patients, however, those with type II had the worst prognosis, while those with type I showed as good a prognosis as the other two groups.

Conclusions. This novel classification based on the degree of BAC involvement in small peripheral lung adenocarcinoma may reflect clinicopathological and prognostic characteristics. This classification may prove practical for planning therapeutic strategies, in particular surgical treatment.

Section snippets

Patients and methods

From 1973 through 1997, 1590 lung cancer patients underwent surgical resection of the lung at our institute, Osaka Medical Center for Cancer and Cardiovascular Diseases in Japan. Of these, the records of 206 patients (13%) with small peripheral lung adenocarcinoma, 2 cm or less in maximum dimension on resection, were studied retrospectively. The mean patient age was 59.9 years, and the male to female ratio was 1.26 (115 to 91). The cases were classified according to the TNM classification and

Results

Of the 206 patients with small peripheral lung adenocarcinoma, 40 patients (19%) had tumors of type I, 75 (36%) of type II, 74 (36%) of type III, and 17 (8%) of type IV. Table 1shows a summary of the association between each type and the clinicopathological factors.

The patients with less severe BAC, for example those with type I and II, included a large number of males (p = 0.029) and smokers (p = 0.0008). Also, such patients showed significantly more aggressive nodal involvement (p < 0.0001);

Comment

Based on the results using the proposed system for classifying small peripheral lung adenocarcinoma, tumors with less BAC, namely types I and II showed significantly more aggressive nodal involvement (p < 0.0001). The incidence of node-positive cases amounted to 38% for type I and 35% for type II, as opposed to just 9% for type III, and interestingly 0% for type IV. Nevertheless, there was a problem regarding the background of patients in our series, as patients underwent various types of

Acknowledgements

This work was supported in part by a Grant-in-Aid for Cancer Research (9-18) from the Ministry of Health and Welfare, Japan.

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Original Articles: General ThoracicPrognostic value of bronchiolo-alveolar carcinoma component of small lung adenocarcinoma

Abstract

Section snippets

Patients and methods

Results

Comment

Acknowledgements

Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Chest

Ann Thorac Surg

J Thorac Cardiovasc Surg

Am J Surg

J Thorac Cardiovasc Surg

Original Articles: General Thoracic
Prognostic value of bronchiolo-alveolar carcinoma component of small lung adenocarcinoma