Bronchioloalveolar Carcinoma in African Americans: RESULTS

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Eight-hundred-thirty-five cases of lung cancers were diagnosed between 1984 and 1999 at this hospital. ВАС constituted 3% (27) of lung cancers and 10.5% of adenocarcinomas. The most common neoplasm was adenocarcinoma, accounting for 256 cases (30.7%) followed by squamous-cell carcinoma in 228 cases (27.3%), small-cell carcinoma in 88 cases (10.5%), large-cell carcinoma in 57 cases (6.8%) and other (including metastatic) carcinomas in 179 cases (21.4%). In other series in which ВАС was described separately, its incidence ranged from 1.1% to 6.5%. When described as subtype of adenocarcinoma, it accounted for 15-20% of cases.

Nine patients (47%) presented with stage 1, five (26%) with stage 2, three (16%) with stage three, and two (10%) with stage 4. Twenty-one (four cases) percent were nonsmokers, compared to 35% reported by Feldman in a mainly Caucasian population (p=0.51). Two cases (10%) had scar formation at the site of cancer, and both of them had history of previous tubercu­losis (p=0.26). This finding concurs with previous studies, reporting 6.9-29% association with scars. In our study, male-to-female ratio was 3:1, whereas the Mayo study has reported 1:1 ratio (p=0.21). The average age of 63 years matches with other studies. Three (17%) cases were discovered incidentally, presenting as solitary nodule on chest x-rays. Productive cough was the most common symptom reported by five (26%) patients (p=0.008), followed by hemoptysis in three (16%) patients (p=l .00) (Table 2). This is in contrast with other studies reporting cough to be nonproductive. A solitary lung mass was found in 13 (68%) cases, pneumonic form in six (32%) cases, and multiple nodules in two (10%) cases. A combination of the above radiological findings was seen in 35% of cases. Previous studies have reported more than 50% incidence of single nodules. Four cases had lymph node (mediastinal) metastases (p=0.30), two had metastases to chest wall (p=0.26), two had brain metastases (p=1.0), and two had pleural effusions, while one patient had a cavitary lesion (Table 3). Pathological review showed mucinous type, accounting for four (21%) cases in our series, nonmucinous type for 13 (68%) cases, and sclerotic type for two (10%) of 19 cases. Earlier studies reported 50% incidence of mucinous ВАС. Seven (37%) cases were diagnosed by transbronchial biopsy, six (32%) had surgical resec-tionbiopsy, three (16%) by CT-guided needle biopsy, whereas two underwent video-assisted thoracoscopy.
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Table 2. Symptoms

Symptoms	Number of Patients (%) HUH (N=19)	Number of Patients (%) Mayo (N=25)*	P Value
Sputum production	5 (26%)	17(68%)	0.008
Cough	5 (26%)	15 (60%)	0.04
Hemoptysis	3 (16%)	4(16%)	1.00
Chest pain	1 (5%)	10(40%)	0.01
Shortness of breath	2 (10%)	14(56%)	0.004
* Data from (Ref 24). By permission of Mayo Foundation.

One patient opted for palliative/supportive care. Sixteen (84%) had surgical resections (eight wedge, seven lobectomy, one segmentectomy). Eight patients received radiotherapy, five had chemotherapy (four-carboplatin & VP 16, one-taxol & 5-FU). Response to chemotherapy was poor, with average survival of nine months. Overall average survival was 23 months (seven days to seven years). Eight patients presenting with stage-1 disease and undergoing wedge resection had the best five-year survival (75%). Two patients who presented with stage-4 disease and received only hemotherapy had the worst survival (mean seven months). Overall significant p values were seen with sputum production (p=0.008), chest pain (p=0.01), shortness of breath (p=0.004), and metastases to contralateral lung (p=0.00006).
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Table 3. Sites of Metastases

Sites	Number of Patients (%) HUH (N=19)	Number of Patients (%) Mayo (N=25)*	P Value
Hilar nodes	5 (26%)	1 (4%)	0.07
Mediastinal nodes	3 (16%)	1 (4%)	0.30
Supraclavicular nodes	1 (5%)	5 (20%)	0.21
Contralateral lung	2 (10%)	18 (72%)	0.00006
Pleura	2 (10%)	2 (8%)	1.00
Pericardium	1 (5%)	0
Liver	2 (10%)	1 (4%)	0.57
Chest wall/ribs	2 (10%)	7 (28%)	0.261
Brain	1 (5%)	2 (8%)	1.00