[胸腺上皮肿瘤分级的临床病理意义]

Chen G, Chen W, He W, Jiang Y, Zhou Y, Huang O

Department of Pathology, Shanghai Chest Hospital, Shanghai 200030, China.

Zhonghua Bing Li Xue Za Zhi. 2001 Apr;30(2):105-9.

OBJECTIVE

To study the clinicopathologic relevance of a thymic epithelial tumor (TET) grading standard with the WHO classification.

METHODS

A grading system for TET was proposed based on the application of WHO histological typing of thymic tumors and analyzed in relation to clinical therapy results and follow-up data of 200 TET cases.

RESULTS

In this series, 8 patients (4.0%) belonged to type A, 68 (34.0%) were type AB, 17 (8.5%) were type B1, 39 (19.5%) were type B2, 27 (13.5%) were type B3 and 36 (18.0%) were type C. The remaining 5 cases were rare thymomas. The overall postoperative survival data showed highly significant differences among the histological subtypes (P < 0.001). Type A & type AB thymomas showed excellent prognosis, none of these patients died of tumor; in type B1, only 1 case (5.9%) died at 22 months postoperatively. Types B2, B3 and C thymomas shared the bad, worse and worst prognosis. Ninety-six patients (48.0%) were in stage I, 26 (13.0%) in stage II, 65 (32.5%) in stage III and 13 (6.5%) in stage IV. Clinical stage is also highly significant in predicting survival (P < 0.001). It was found that tumor histology could predict survival expectancies well in stage I and stage II cases. It was also found that type B2, B3 and C thymomas had a statistically significant worse prognosis than type A, AB and B1 thymomas (P < 0.001). According to the histology, clinical data, biological behavior and prognosis, it is proposed that thymomas be divided into 4 grades: grade I, II, III and IV. Follow-up is the best strategy for grade I & II patients after radical surgery. In this series, the 30 patients (15.0%) presenting clinical signs of myasthenia gravis were mostly in type B2 and B3 groups (P < 0.01).

CONCLUSIONS

The WHO classification for TET provides good pathological definitions and criteria for diagnosis, which can independently predict the invasiveness and prognosis of TET. TET grading is of use in unifying pathological and clinical findings, in selection of proper therapy and in predicting prognosis.

目的

研究胸腺上皮肿瘤（TET）分级标准与世界卫生组织（WHO）分类的临床病理相关性。

方法

基于WHO胸腺肿瘤组织学类型的应用，提出了一种TET分级系统，并结合200例TET病例的临床治疗结果和随访数据进行分析。

结果

在本系列中，8例（4.0%）属于A型，68例（34.0%）为AB型，17例（8.5%）为B1型，39例（19.5%）为B2型，27例（13.5%）为B3型，36例（18.0%）为C型。其余5例为罕见胸腺瘤。总体术后生存数据显示组织学亚型之间存在高度显著差异（P<0.001）。A型和AB型胸腺瘤预后良好，这些患者均未死于肿瘤；在B1型中，仅1例（5.9%）在术后22个月死亡。B2型、B3型和C型胸腺瘤的预后分别为差、较差和最差。96例（48.0%）处于I期，26例（13.0%）处于II期，65例（32.5%）处于III期，13例（6.5%）处于IV期。临床分期在预测生存方面也具有高度显著性（P<0.001）。研究发现，肿瘤组织学在I期和II期病例中能很好地预测生存预期。还发现B2型、B3型和C型胸腺瘤的预后在统计学上显著差于A型、AB型和B1型胸腺瘤（P<0.001）。根据组织学、临床数据、生物学行为和预后，建议将胸腺瘤分为I、II、III和IV级。对于I级和II级患者，根治性手术后随访是最佳策略。在本系列中，出现重症肌无力临床症状的30例患者（15.0%）大多在B2型和B3型组（P<0.01）。