Long-term survival differences for bronchiolo-alveolar carcinoma patients with ipsilateral intrapulmonary metastasis at diagnosis

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Abstract
Background: It has been suggested that the current staging system does not accurately reflect survival outcomes for advanced bronchiolo-alveolar carcinoma (BAC) patients. Methods: We conducted a case-only analysis of US Surveillance, Epidemiology, and End Results (SEER) data (1998–2002). Overall survival (OS) and lung cancer-specific survival (LCSS) univariate analyses were conducted using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazards ratios. Results: 2345 incident cases of BAC were analyzed, including 707 patients with stage IIIB or IV BAC. Patients with stage IIIB BAC due to multiple lesions in the same lobe (n = 93) had significantly improved median OS (46m) and LCSS (>58m) compared to other stage IIIB BAC patients (n = 111; OS = 9m, P < 0.0001; LCSS = 10m, P < 0.0001). Among stage IV BAC patients, those with intrapulmonary metastasis (n = 278) had significantly improved median OS (13m) and LCSS (15m) compared to those with distant metastasis (n = 225; OS = 7m, P < 0.0001; LCSS = 7m, P = 0.0001). These survival differences persisted after adjustment for age, gender, ethnicity, and surgical treatment status. Conclusions: Among stage IIIB and IV BAC patients, those presenting with ipsilateral intrapulmonary metastasis have improved survival outcomes. Our results add further support for modification to the current staging system for BAC.