Sonobe M, Nakagawa M, Ichinose M, Ikegami N, Nagasawa M, Shindo T
Department of Thoracic Surgery, Tenri Hospital, Mishima-cho 200, Tenri, Nara 632-8552, Japan.
Jpn J Thorac Cardiovasc Surg. 2001 Jan;49(1):35-41. doi: 10.1007/BF02913121.
We evaluated the prognostic factors for thymoma that remain controversial.
We studied 72 consecutive patients treated for thymoma during the period between 1966 and 1997. Recurrence-free interval rates and overall survival rates calculated by the Kaplan-Meier method were compared using log-rank test by the Masaoka stage, extent of surgical resection, histology, or associated disease(s). Multivariate analysis was performed using Cox's proportional hazards model.
Thirty-two thymomas were at Masaoka stage I, 9 at stage II, 15 at stage III, and 16 were at stage IV. There were 56 complete resections, 7 incomplete resections (2 at stage III and 5 at stage IV), and 9 biopsies (1 at stage III and 8 at stage IV). Forty-one thymomas were cortical, 16 medullary, and 15 were mixed form. Association of myasthenia gravis was found in 20 patients, and pure red cell aplasia in 7. After an average follow-up period of 103 months, the recurrence-free 5-, 10-, 15-year interval rate was 89%, 80%, 80%, respectively, and overall 5-, 10-, 15-year survival rate was 86%, 71%, 59%, respectively. Factors influencing the recurrence-free interval and overall survival included the Masaoka stage, extent of surgical resection, and association with pure red cell aplasia. Multivariate analysis revealed stage IV tumor and association with pure red cell aplasia as risk factors for recurrence. Pure red cell aplasia indicated poor prognosis for overall survival.
Masaoka stage, extent of surgical resection, and association with pure red cell aplasia were prognostic factors for thymoma. Multidisciplinary treatment for stage IV tumors and better control of pure red cell aplasia, if associated, should be investigated.
我们评估了胸腺瘤仍存在争议的预后因素。
我们研究了1966年至1997年间连续接受胸腺瘤治疗的72例患者。采用Kaplan-Meier法计算的无复发生存率和总生存率，通过Masaoka分期、手术切除范围、组织学或相关疾病，使用对数秩检验进行比较。使用Cox比例风险模型进行多变量分析。
32例胸腺瘤处于Masaoka I期，9例处于II期，15例处于III期，16例处于IV期。有56例完整切除，7例不完全切除（III期2例，IV期5例），9例活检（III期1例，IV期8例）。41例胸腺瘤为皮质型，16例为髓质型，15例为混合型。20例患者发现合并重症肌无力，7例合并纯红细胞再生障碍性贫血。平均随访103个月后，5年、10年、15年无复发生存率分别为89%、80%、80%，总5年、10年、15年生存率分别为86%、71%、59%。影响无复发生存期和总生存的因素包括Masaoka分期、手术切除范围以及与纯红细胞再生障碍性贫血的相关性。多变量分析显示IV期肿瘤和与纯红细胞再生障碍性贫血的相关性是复发的危险因素。纯红细胞再生障碍性贫血提示总生存预后不良。
Masaoka分期、手术切除范围以及与纯红细胞再生障碍性贫血的相关性是胸腺瘤的预后因素。对于IV期肿瘤应研究多学科治疗方法，若合并纯红细胞再生障碍性贫血应更好地加以控制。
