Bronchioloalveolar carcinoma in African Americans

Purpose: To review the clinical and pathophysiological features of bronchioloalveolar carcinoma (BAC) in African Americans. Patients and Methods: This is a retrospective review of 19 cases of BAC at Howard University Hospital between 1984 and 1999. Twenty-seven cases were identified. Medical records of 19 patients (15 men and four women) were available for review. The pathological reports were reviewed. The clinical and pathological features of this disease were compared with another study by Feldman et al. from the Mayo Clinic reporting on 25 patients (predominantly Caucasians) with metastatic BAC. Results: Of 835 cases of lung cancers diagnosed at our institution between 1984 and 1999, 27 cases of BAC were identified. Only 19 charts were available for review from the Howard University (HU) tumor registry. These were not consecutive cases. Four of 19 (21%) HU cases were nonsmokers compared to eight of 25 (32%) Mayo cases (p = 0.51). Productive cough was the most common symptom in both HU and Mayo patients, and was less common in HU patients than Mayo patients (26% versus 68%; P = 0.008). In contrast, hemoptysis occurred in 16% of patients in both institutions (p = 1.00). Other studies have reported cough to be mostly nonproductive. Pathological review showed mucinous BAC accounting for 21% (four cases), nonmucinous for 68% (13 cases), and sclerotic for 10% (two) of cases. Earlier studies have reported 50% incidence of mucinous BAC. Sixteen had surgical resections (eight wedge, seven lobectomy, one segmentectomy). Eight patients received radiotherapy. Response to chemotherapy was poor, with average survival of nine months. Overall, average survival was 23 months (seven days to seven years). Eight out of nine patients who presented with stage-1 disease underwent wedge resection were noted to have the best five-year survival (75%). Five patients presented with stage 2, and three patients with stage-3 disease. Two patients who presented with stage-4 diease and received chemotherapy alone had the worst survival (mean seven months). Further subclassification into stages A and B were not available from the chart. Conclusion: Our study is the first published review of clinical and pathophysiological features of BAC in African Americans. The study showed differences' in the clinical features, histopathology, and radiological features among Caucasians and African Americans.