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J Thorac Cardiovasc Surg 2001;121:0042-0047
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery

Bronchioloalveolar carcinoma of the lung: Recurrences and survival in patients with stage I disease

From the Lowe Center for Thoracic Oncology,^a Division of Experimental Medicine,^b Department of Adult Oncology, Dana Farber Cancer Institute, and the Biostatistics Group, Massachusetts General Hospital Cancer Center,^c Department of Pathology,^d Brigham and Women's Hospital, Division of Thoracic Surgery,^e Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Received for publication March 13, 2000. Revisions requested June 19, 2000; revisions received July 3, 2000. Accepted for publication July 18, 2000. Address for reprints: Oscar S. Breathnach, MD, Lowe Center for Thoracic Oncology, The Dana Farber Cancer Institute, Dana 1234, 44, Binney St, Boston, MA 02115.

Objectives: The aim of our study was to retrospectively compare the patient characteristics, the frequency and pattern of recurrent disease, and survival in patients with stage I bronchioloalveolar carcinoma and adenocarcinoma of the lung.
Methods: Patients with stage I bronchioloalveolar carcinoma or adenocarcinoma other than bronchioloalveolar carcinoma resected between 1984 and 1992 with adequate clinical follow-up were studied. The clinical characteristics of the patients, extent of initial surgical resection, sites of recurrent disease, and overall survival were examined and compared between the 2 groups. The median follow-up for patients with bronchioloalveolar carcinoma and adenocarcinoma was 6.2 years and 5.9 years, respectively.
Results: A total of 138 patients were identified. Thirty-three patients had bronchioloalveolar carcinoma and 105 patients had adenocarcinoma. Eleven (33%) of the patients with bronchioloalveolar carcinoma had never smoked cigarettes versus 9 (9%) of the patients with adenocarcinoma (P = .0036). There were no significant differences between patients with bronchioloalveolar carcinoma and adenocarcinoma in sex distribution and overall recurrence rate. Of the 12 patients with recurrent bronchioloalveolar carcinoma, 1 patient (8%) had extrathoracic disease develop at the site of first recurrence compared with 49% of patients with recurrent adenocarcinoma (P < .001). The 5-year survival in patients with bronchioloalveolar carcinoma and in those with adenocarcinoma was 83% and 63%, respectively (P = .04).
Conclusions: Stage I bronchioloalveolar carcinoma is more likely to occur in nonsmokers. Survival is longer in patients with bronchioloalveolar carcinoma. Further research is warranted to define the etiology, clinical course, and molecular abnormalities in patients with bronchioloalveolar carcinoma to generate more effective therapeutic approaches.

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