Krüger M, Uschinsky K, Engelmann C
Thoraxchirurgische Klinik, Fachkrankenhaus für Lungenheilkunde und Thoraxchirurgie (FLT), Berlin-Buch.
Zentralbl Chir. 2001 Mar;126(3):223-8. doi: 10.1055/s-2001-12494.
The objective of this study is to evaluate the results after surgical treatment of malignant tumors arising from the peripheral nerves of the thorax under consideration of adjuvant therapy modalities.
Between 1988 and 1998, 9 patients (6 males, 3 females) underwent surgical treatment for MTNSO and 35 pts. for benign neurogenic tumors. The mean age in patients with malignant tumors was 45 years (range, 25 to 73 years). 3 pts. with MTNSO (33.3%) had neurofibromatosis (von Recklinghausen's syndrome) compared to 8.6% (3/35) in patients with benign neurogenic tumors.
In patients with MTNSO partial chest wall resections (n = 4) including sternectomy (n = 1), lung resections (n = 2), paravertebral (n = 1) and mediastinal tumor resection (n = 1) and palliative resection of pleural recurrence (n = 1) were performed. Radical resection was achieved in 5 pts. (55.5%). There was no postoperative mortality. 3 patients (33.3%) had postoperative complications: wound infection (n = 2) and wound dehiscence due to fall with consequent pleural infection (n = 1). Adjuvant therapy was performed in two pts. (adjuvant radiotherapy/chemotherapy for metastatic disease n = 1; adjuvant chemotherapy/adjuvant radiotherapy after resection of recurrent tumor n = 1). Early recurrence is documented in 2 pts. (after 3 and 6 months). Two pts. are alive and free of disease at three years, and the patient after sternectomy with recurrent disease at 20 months. Three pts. died 8, 9 and 26 months after the primary surgical procedure. The first postoperative examination (at three months) in the remaining patient showed no evidence for recurrent disease.
Patients with MTNSO have an unfavourable prognosis and local recurrence is frequent even after radical surgical therapy. Therefore an adjuvant treatment in these patients may be justified, even if the value of these therapy modalities is not proved yet. A tumor-free long-term survival especially after complete surgical resection is possible in selected cases.
本研究的目的是在考虑辅助治疗方式的情况下，评估胸部周围神经来源的恶性肿瘤手术治疗后的结果。
1988年至1998年间，9例患者（6例男性，3例女性）接受了恶性周围神经鞘膜瘤（MTNSO）的手术治疗，35例患者接受了良性神经源性肿瘤的手术治疗。恶性肿瘤患者的平均年龄为45岁（范围25至73岁）。3例MTNSO患者（33.3%）患有神经纤维瘤病（冯·雷克林豪森综合征），而良性神经源性肿瘤患者中这一比例为8.6%（3/35）。
对于MTNSO患者，进行了部分胸壁切除术（n = 4），包括胸骨切除术（n = 1）、肺切除术（n = 2）、椎旁肿瘤切除术（n = 1）和纵隔肿瘤切除术（n = 1）以及胸膜复发的姑息性切除术（n = 1）。5例患者（55.5%）实现了根治性切除。无术后死亡病例。3例患者（33.3%）出现术后并发症：伤口感染（n = 2）以及因跌倒导致伤口裂开并继发胸膜感染（n = 1）。2例患者接受了辅助治疗（1例为针对转移性疾病的辅助放疗/化疗；1例为复发性肿瘤切除术后的辅助化疗/辅助放疗）。2例患者出现早期复发（分别在3个月和6个月后）。2例患者在3年后存活且无疾病，胸骨切除术后复发的患者在20个月时仍存活。3例患者在初次手术后8、9和26个月死亡。其余患者术后首次检查（3个月时）未发现复发疾病迹象。
MTNSO患者预后不良，即使经过根治性手术治疗，局部复发仍很常见。因此，即使这些治疗方式的价值尚未得到证实，对这些患者进行辅助治疗可能是合理的。在部分病例中，尤其是在完全手术切除后，实现无瘤长期生存是可能的。
