Tseng Yau-Lin, Wang Shan-Tair, Wu Ming-Ho, Lin Mu-Yen, Lai Wu-Wei, Cheng Fen-Fen
Institute of Clinical Medicine, Taiwan, Tainan, China
Ann Thorac Surg. 2003 Oct;76(4):1041-5. doi: 10.1016/s0003-4975(03)00831-2.
Thymic carcinoma is a rare, indolent, and invasive cancer. This study investigated the treatment results of thymic carcinoma and clinical prognostic factors.
From June 1988 to January 2002, 38 patients were enrolled in this study with the diagnosis of thymic carcinoma in the Cheng-Kung University Hospital based on Rosai's and Muller-Hermelink's classification. Clinical and pathologic data were retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier, log rank, and Wilcoxon tests. Statistical significance was defined as p < 0.05.
Pathology revealed 14 poorly differentiated, 6 moderately differentiated, and 8 well-differentiated squamous cell carcinomas; 8 lymphoepithelioma-like carcinomas; and 2 other carcinomas. Pathologic staging using the Masaoka system included 6 stage II, 23 stage III, and 9 stage IV patients. Six biopsies, five debulkings, and 27 complete resections were performed. All patients were followed from 15 months to 10 years 9 months, with an average of 53.8 months. Median survival time was 81 months, and median recurrence time was 52 months. Eighteen patients are still alive, and 7 are alive with disease. Well-differentiated squamous cell carcinoma had better prognosis than other carcinomas (p = 0.022). Complete resection significantly increased survival rate (p < 0.001). Tumor invasion of the superior vena cava, pulmonary vessels, or aorta were significant predictors for poor prognosis (p = 0.016, 0.002, and 0.002, respectively).
Only patients with thymic carcinoma who underwent complete resection had long-term survival. Prognosis of thymic carcinoma seemed mainly dependent on tumor invasion of the great vessels.
胸腺癌是一种罕见、生长缓慢且具有侵袭性的癌症。本研究调查了胸腺癌的治疗结果及临床预后因素。
1988年6月至2002年1月，38例在成功大学医院被诊断为胸腺癌的患者纳入本研究，诊断依据Rosai和Muller-Hermelink分类法。对临床和病理数据进行回顾性分析。采用Kaplan-Meier法、对数秩检验和Wilcoxon检验进行生存分析。统计学显著性定义为p<0.05。
病理显示14例低分化、6例中分化和8例高分化鳞状细胞癌；8例淋巴上皮瘤样癌；以及2例其他类型癌症。采用Masaoka系统进行病理分期，包括6例II期、23例III期和9例IV期患者。进行了6次活检、5次肿瘤减积手术和27次完整切除手术。所有患者随访时间为15个月至10年9个月，平均53.8个月。中位生存时间为81个月，中位复发时间为52个月。18例患者仍存活，7例带瘤存活。高分化鳞状细胞癌的预后优于其他类型癌症（p = 0.022）。完整切除显著提高了生存率（p<0.001）。肿瘤侵犯上腔静脉、肺血管或主动脉是预后不良的重要预测因素（分别为p = 0.016、0.002和0.002）。
只有接受完整切除的胸腺癌患者才能获得长期生存。胸腺癌的预后似乎主要取决于肿瘤对大血管的侵犯。
