Wright Cameron D
Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Ann Thorac Surg. 2006 Oct;82(4):1234-9. doi: 10.1016/j.athoracsur.2006.05.028.
The treatment of locally advanced Masaoka stage IVA thymoma is not standardized and is problematic.
A single-institution retrospective study was made of 5 patients with World Health Organization B3 thymomas who underwent pleuropneumonectomy for locally advanced thymoma. Two patients had recurrent thymoma and 3 presented de novo with stage IVA disease. Patients had a variety of induction and adjuvant treatments.
There was no operative mortality, and only 1 patient had a major complication. Several patients had relatively prolonged disease-free survival. The median survival was 86 months, and the Kaplan-Meier survival was 75% (95% confidence interval: 53% to 97%) at 5 years and 50% (95% confidence interval: 25% to 75%) at 10 years.
Pleuropneumonectomy can be performed safely in patients with advanced thymomas and may improve survival. Highly selected patients might be cured with this approach if a complete resection is performed. While the optimal multimodality strategy for these patients is unknown, induction chemotherapy followed by resection then chemoradiotherapy seems promising.
局部晚期Masaoka IVA期胸腺瘤的治疗尚无标准化方案，且存在问题。
对5例世界卫生组织B3型胸腺瘤患者进行单机构回顾性研究，这些患者因局部晚期胸腺瘤接受了胸膜肺切除术。2例为复发性胸腺瘤，3例初诊为IVA期疾病。患者接受了多种诱导和辅助治疗。
无手术死亡病例，仅1例患者出现严重并发症。部分患者的无病生存期相对延长。中位生存期为86个月，5年时的Kaplan-Meier生存率为75%（95%置信区间：53%至97%），10年时为50%（95%置信区间：25%至75%）。
晚期胸腺瘤患者可安全地进行胸膜肺切除术，且可能改善生存率。如果能完整切除，经过严格挑选的患者可能通过这种方法治愈。虽然这些患者的最佳多模式治疗策略尚不清楚，但诱导化疗后切除，然后进行放化疗似乎很有前景。
