Liu H-C, Chen Y-J, Tzen C-Y, Huang C-J, Chang C-C, Huang W-C
Division of Thoracic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sector 2, Chung-San North Road, Taipei, Taiwan.
Eur J Surg Oncol. 2006 Nov;32(9):1000-5. doi: 10.1016/j.ejso.2006.03.049. Epub 2006 May 12.
This study was conducted to evaluate the efficacy of debulking surgery in the treatment of locally advanced but operable malignant thymoma.
We reviewed 43 cases with incompletely resected stage III and IVa malignant thymoma managed between January 1987 and December 2002.
Twenty-two had stage III and 21 had stage IVa disease. Maximal debulking was performed in 15 patients, nine with stage III and six with stage IVa disease. Nine patients also had myasthenia gravis (MG). Using univariate Kaplan-Meier analysis, we found that maximal debulking surgery, RT, and with the presence of MG were associated with better survival. Debulking resulted in a better outcome than non-debulking surgery (mean survival: 106 months vs 57.2 months). After adjustment with multivariate analysis, RT and MG were both associated with better survival. CT did not appear to be beneficial for advanced thymoma.
RT is independently associated with a better outcome in locally advanced thymoma. Debulking surgery apparently allows for a better response to RT.
本研究旨在评估减瘤手术治疗局部晚期但可切除的恶性胸腺瘤的疗效。
我们回顾了1987年1月至2002年12月期间收治的43例Ⅲ期和Ⅳa期恶性胸腺瘤不完全切除病例。
22例为Ⅲ期，21例为Ⅳa期。15例患者进行了最大程度减瘤手术，其中9例为Ⅲ期，6例为Ⅳa期。9例患者还患有重症肌无力（MG）。采用单因素Kaplan-Meier分析，我们发现最大程度减瘤手术、放疗以及合并MG与较好的生存率相关。减瘤手术的结果优于未进行减瘤手术（平均生存期：106个月对57.2个月）。经过多因素分析调整后，放疗和MG均与较好的生存率相关。CT对晚期胸腺瘤似乎并无益处。
放疗与局部晚期胸腺瘤较好的预后独立相关。减瘤手术显然能使对放疗的反应更好。
