Ogawa Kazuhiko, Toita Takafumi, Uno Takashi, Fuwa Nobukazu, Kakinohana Yasumasa, Kamata Minoru, Koja Kageharu, Kinjo Takao, Adachi Genki, Murayama Sadayuki
Department of Radiology, University of the Ryukyus School of Medicine, Okinawa, Japan.
Cancer. 2002 Jun 15;94(12):3115-9. doi: 10.1002/cncr.10588.
Thymic carcinomas are rare neoplasms, and information regarding the results of treatment and possible prognostic factors in patients with these tumors is limited.
The records of 40 patients with histologically confirmed thymic carcinoma who were treated between 1984 and 1998 were reviewed. Twenty-seven patients were treated with surgical resection followed by radiotherapy with or without chemotherapy, and the remaining 13 patients were treated with radiotherapy with or without chemotherapy. The median follow-up time for the 13 surviving patients was 87 months (range, 44-193 months).
The 5-year and 10-year actuarial overall survival rates in all patients were 38% and 28%, respectively. On univariate analysis, complete resection, Karnofsky performance status (KPS), histology, and Masaoka stage at the time of diagnosis were found to have a significant impact on overall survival, whereas on multivariate analysis, complete resection, KPS, and histology were found to be significant prognostic factors. With regard to the degree of resection, 12 of 16 patients (75%) treated with complete resection were alive and free of disease at the time of last follow-up whereas 1 of 24 patients (4%) treated with incomplete resection or biopsy still was alive. Among 12 surviving patients treated with complete resection, 8 with resectable tumors at the time of presentation all had low-grade histology (squamous cell carcinoma) and were treated successfully with complete resection and postoperative radiotherapy with or without adjuvant chemotherapy. The remaining four patients with unresectable tumors at the time of presentation were treated successfully with neoadjuvant chemotherapy, complete resection, and postoperative radiotherapy.
The results of the current study indicate that multimodal treatment, especially complete resection and postoperative radiotherapy with or without chemotherapy, is a curative therapy for thymic carcinomas.
胸腺癌是罕见肿瘤，关于这些肿瘤患者的治疗结果及可能的预后因素的信息有限。
回顾了1984年至1998年间接受治疗的40例组织学确诊胸腺癌患者的记录。27例患者接受手术切除，随后进行放疗，可联合或不联合化疗，其余13例患者接受放疗，可联合或不联合化疗。13例存活患者的中位随访时间为87个月（范围44 - 193个月）。
所有患者的5年和10年精算总生存率分别为38%和28%。单因素分析发现，完整切除、卡氏功能状态评分（KPS）、组织学类型以及诊断时的Masaoka分期对总生存有显著影响，而多因素分析发现，完整切除、KPS评分和组织学类型是显著的预后因素。关于切除程度，16例接受完整切除的患者中有12例（75%）在最后一次随访时存活且无疾病，而24例接受不完全切除或活检的患者中有1例（4%）仍存活。在12例接受完整切除的存活患者中，8例初诊时肿瘤可切除的患者均为低级别组织学类型（鳞状细胞癌），通过完整切除及术后放疗联合或不联合辅助化疗成功治疗。其余4例初诊时肿瘤不可切除的患者通过新辅助化疗、完整切除及术后放疗成功治疗。
本研究结果表明，多模式治疗，尤其是完整切除及术后放疗联合或不联合化疗，是胸腺癌的一种治愈性疗法。
