肺移植治疗细支气管肺泡癌
发布于 2004-01-30 · 浏览 819 · IP 上海上海
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J Thorac Cardiovasc Surg. 2003 Jan; 125(1): 45-8.
Comment in:
J Thorac Cardiovasc Surg. 2003 Jan;125(1):20-2.
Pulmonary transplantation for advanced bronchioloalveolar carcinoma.
Zorn GL Jr, McGiffin DC, Young KR Jr, Alexander CB, Weill D, Kirklin JK.Departments of Surgery, The University of Alabama at Birmingham, Birmingham, Ala. 35294-0016, USA. gzorn@uab.edu
BACKGROUND: No effective therapy is currently available for the diffuse stage of bronchioloalveolar carcinoma.
OBJECTIVE: We tested the hypothesis that total lung replacement with standard lung transplantation techniques would provide curative therapy.
METHODS: Nine patients aged 31 to 58 years with bronchioloalveolar carcinoma were entered in the study. Five patients initially had bilateral diffuse tumor. Four patients had recurrence in the contralateral lung after pulmonary resection.
RESULTS: Between 1993 and 1998, all 9 patients underwent transplantation (2 single-lung and 7 bilateral transplants, 1 reoperative single-lung transplant, and 1 reoperative bilateral transplant). Two patients had mediastinal node metastasis (level 7) at the time of transplantation, and 1 of these had a frankly invasive adenocarcinoma. Of the 8 patients with pure bronchioloalveolar carcinoma, 6 had recurrent pulmonary tumor after transplantation. In 2 of these patients the tumor was localized and could be resected with left lower lobectomy in one case and left pneumonectomy in the other. One is alive 89 months after transplantation; the other died 82 months after transplantation. Four other patients had a diffuse pattern of pulmonary recurrence. Two died of progressive pulmonary failure; 1 of these had retransplantation with recurrence. A third patient died of cerebral edema shortly after bilateral retransplantation. The other patient is alive with recurrence 39 months after transplantation and has bronchiolitis obliterans. Two patients without recurrence are well with unrestricted performance levels 87 and 76 months after transplantation.
CONCLUSIONS: Transplantation produces a powerful palliative outcome in patients with advanced bronchioloalveolar carcinoma, but the recurrence rate is high. Transplantation for this indication remains controversial.
肺移植治疗细支气管肺泡癌
背景：目前尚无有效的治疗弥散期细支气管肺泡癌的方法
目的：验证全肺移植技术可能根治该病的假说。
方法：9例年龄31-58岁的细支气管肺泡癌患者入组。5例治疗时即有双侧弥散肿瘤。4例为术后对侧复发。
结果：从1993到1998年，所有9例患者接受了移植（2例单侧肺，7例双侧肺移植，1例单侧二次移植，1例双侧二次移植）。2例患者在移植时有纵膈淋巴结转移（level 7），1例为有明确浸润的腺癌。在8例细支气管肺泡癌患者中，6例发生移植后复发。其中的2例由于肿瘤局限分别接受了左下肺叶切除和左侧肺切除。1例移植后89个月仍存活；1例存活82个月。4例发生弥散型复发。2例死于进行性肺功能衰竭；其中1例再次移植。1例在双侧再次移植后即很快死于脑水肿。其他患者存活，在移植后39个月发生复发和阻塞性细支气管炎。2例未复发，体力活动不受限，分别存活87和76个月。
结论：对于进展期细支气管肺泡癌，肺移植可以很好地改善预后，但是复发率高。该病能否成为肺移植的适应证仍存在争议。
Comment in:
J Thorac Cardiovasc Surg. 2003 Jan;125(1):20-2.
Pulmonary transplantation for advanced bronchioloalveolar carcinoma.
Zorn GL Jr, McGiffin DC, Young KR Jr, Alexander CB, Weill D, Kirklin JK.Departments of Surgery, The University of Alabama at Birmingham, Birmingham, Ala. 35294-0016, USA. gzorn@uab.edu
BACKGROUND: No effective therapy is currently available for the diffuse stage of bronchioloalveolar carcinoma.
OBJECTIVE: We tested the hypothesis that total lung replacement with standard lung transplantation techniques would provide curative therapy.
METHODS: Nine patients aged 31 to 58 years with bronchioloalveolar carcinoma were entered in the study. Five patients initially had bilateral diffuse tumor. Four patients had recurrence in the contralateral lung after pulmonary resection.
RESULTS: Between 1993 and 1998, all 9 patients underwent transplantation (2 single-lung and 7 bilateral transplants, 1 reoperative single-lung transplant, and 1 reoperative bilateral transplant). Two patients had mediastinal node metastasis (level 7) at the time of transplantation, and 1 of these had a frankly invasive adenocarcinoma. Of the 8 patients with pure bronchioloalveolar carcinoma, 6 had recurrent pulmonary tumor after transplantation. In 2 of these patients the tumor was localized and could be resected with left lower lobectomy in one case and left pneumonectomy in the other. One is alive 89 months after transplantation; the other died 82 months after transplantation. Four other patients had a diffuse pattern of pulmonary recurrence. Two died of progressive pulmonary failure; 1 of these had retransplantation with recurrence. A third patient died of cerebral edema shortly after bilateral retransplantation. The other patient is alive with recurrence 39 months after transplantation and has bronchiolitis obliterans. Two patients without recurrence are well with unrestricted performance levels 87 and 76 months after transplantation.
CONCLUSIONS: Transplantation produces a powerful palliative outcome in patients with advanced bronchioloalveolar carcinoma, but the recurrence rate is high. Transplantation for this indication remains controversial.
背景：目前尚无有效的治疗弥散期细支气管肺泡癌的方法
目的：验证全肺移植技术可能根治该病的假说。
方法：9例年龄31-58岁的细支气管肺泡癌患者入组。5例治疗时即有双侧弥散肿瘤。4例为术后对侧复发。
结果：从1993到1998年，所有9例患者接受了移植（2例单侧肺，7例双侧肺移植，1例单侧二次移植，1例双侧二次移植）。2例患者在移植时有纵膈淋巴结转移（level 7），1例为有明确浸润的腺癌。在8例细支气管肺泡癌患者中，6例发生移植后复发。其中的2例由于肿瘤局限分别接受了左下肺叶切除和左侧肺切除。1例移植后89个月仍存活；1例存活82个月。4例发生弥散型复发。2例死于进行性肺功能衰竭；其中1例再次移植。1例在双侧再次移植后即很快死于脑水肿。其他患者存活，在移植后39个月发生复发和阻塞性细支气管炎。2例未复发，体力活动不受限，分别存活87和76个月。
结论：对于进展期细支气管肺泡癌，肺移植可以很好地改善预后，但是复发率高。该病能否成为肺移植的适应证仍存在争议。
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