Rena Ottavio, Papalia Esther, Maggi Giuliano, Oliaro Alberto, Ruffini Enrico, Filosso Pierluigi, Mancuso Maurizio, Novero Domenico, Casadio Caterina
Thoracic Surgery Department, University of Eastern Piedmont, Maggiore della Carità General Hospital, via Mazzini 18, Novara 28100, Italy.
Lung Cancer. 2005 Oct;50(1):59-66. doi: 10.1016/j.lungcan.2005.05.009.
The histologic classification of thymoma remained controversial since 1999, when the World Health Organization (WHO) Consensus Committee published a histologic typing system for tumours of thymus. Clinical features, postoperative relapsing rates, and survival of patients with thymoma were evaluated with reference to the WHO histologic classification, based on a series of 178 patients, submitted to surgery between 1988 and 2000. There were 21 type A, 49 type AB, 45 type B1, 50 type B2 and 13 type B3 tumours. The invasiveness of tumours was 23.8%, 51%, 73.3%, 82% and 100% for types A, AB, B1, B2 and B3 tumours, respectively. The frequency of invasion of the great vessels increased according to the tumour type in the order A (0%), AB (4%), B1 (6.6%), B2 (22%), and B3 (23%). The 10-year disease-free survival was 95%, 90%, 85%, 71% and 40% for types A, AB, B1, B2 and B3, respectively. According to the Masaoka staging system, the disease-free survival rates were 94%, 88% and 66% for stages I, II and III, respectively, at 10 years. No stage IVA thymomas reached 10 years follow-up. Overall survival at 10 years were 88% and 25% when complete and incomplete resection were considered. By multivariate analysis, Masaoka staging system, WHO histologic classification and complete resection were significant independent prognostic factors, whereas age- and sex-associated myasthenia gravis were not. The present study demonstrated the World Health Organization histologic classification a good prognostic factor, such as completeness of surgical resection and Masaoka staging system.
自1999年世界卫生组织（WHO）共识委员会发布胸腺肿瘤组织学分型系统以来，胸腺瘤的组织学分类一直存在争议。基于1988年至2000年间接受手术的178例患者，参照WHO组织学分类对胸腺瘤患者的临床特征、术后复发率和生存率进行了评估。其中有21例A型、49例AB型、45例B1型、50例B2型和13例B3型肿瘤。A型、AB型、B1型、B2型和B3型肿瘤的侵袭性分别为23.8%、51%、73.3%、82%和100%。大血管受侵频率随肿瘤类型按以下顺序增加：A型（0%）、AB型（4%）、B1型（6.6%）、B2型（22%）和B3型（23%）。A型、AB型、B1型、B2型和B3型的10年无病生存率分别为95%、90%、85%、71%和40%。根据Masaoka分期系统，I期、II期和III期的10年无病生存率分别为94%、88%和66%。没有IVA型胸腺瘤达到10年随访。考虑完整切除和不完整切除时，10年总生存率分别为88%和25%。多因素分析显示，Masaoka分期系统、WHO组织学分类和完整切除是显著的独立预后因素，而与年龄和性别相关的重症肌无力不是。本研究表明，世界卫生组织组织学分类是一个良好的预后因素，如手术切除的完整性和Masaoka分期系统。
