title: Clinical pattern and pathologic stage but not histologic features predict outcome for bronchioloalveolar carcinoma.
abstract: BACKGROUND
  The histologic criteria defining bronchioloalveolar carcinoma (BAC) were recently revised, but it is unclear whether these criteria predict clinical behavior. This study determined the outcome of resected BAC in relationship to clinical and radiologic disease pattern, and pathologic features.
  
  
  METHODS
  Between 1989 and 2000, 100 consecutive surgically treated patients with adenocarcinomas exhibiting various degrees of BAC features were retrospectively studied. Histology was reviewed; tumors were classified as pure BAC, BAC with focal invasion, and adenocarcinoma with BAC features. Clinical and radiologic pattern were classified as unifocal, multifocal, or pneumonic. Demographic data, tumor stage, and outcome were recorded. Survival was analyzed by the Kaplan-Meier method, and prognostic factors were determined by the log-rank test.
  
  
  RESULTS
  Patient median age was 65, and 74% of the patients were female. Pure BAC, BAC with focal invasion, and adenocarcinoma with BAC features occurred in 47, 21, and 32 patients, respectively. Unifocal disease occurred in 64 patients, multifocal in 29, and pneumonic in 7. Seventy-one patients had stage I/II tumors, 22 had stage III/IV, and 7 patients had Stage X tumors. Overall 5-year survival was 74%. There was no significant difference in survival among the three histologic subtypes. The pneumonic pattern had significantly worse survival compared with unifocal and multifocal patterns. Pathologic stage predicted survival, with 5-year survivals for I/II and III/IV of 83.7% and 59.6%, respectively.
  
  
  CONCLUSIONS
  Clinical pattern and pathologic stage, but not the degree of invasion on histologic examination predict survival. Multifocal disease is associated with excellent long-term survival after resection. The favorable survival of stage III/IV BAC indicates that the current staging system does not fully describe this disease in patients undergoing resection because of its distinct tumor behavior.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Ebright
authors.forename: Maureen F
authors.initials: MF
authors.lastname: Zakowski
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Martin
authors.forename: Ennapadam S
authors.initials: ES
authors.lastname: Venkatraman
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Miller
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Bains
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Downey
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Korst
authors.forename: Mark G
authors.initials: MG
authors.lastname: Kris
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
mesh_terms: D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D015996:Survival Rate