胸腺瘤的组织学亚型与预后：108例研究

[Histologic subtyping and prognosis of thymoma: a study of 108 cases].

作者信息

Jiao Xia, Yin Hong-Lin, Lu Zhen-Feng, Zhao You-Cai, Zhou Xiao-Jun

机构信息

Department of Pathology, Nanjing General Hospital of PLA, Nanjing 210002, China.

出版信息

Zhonghua Bing Li Xue Za Zhi. 2008 Jul;37(7):445-9.

PMID:19035114

Abstract

OBJECTIVE

To study the prognostic and clinical relevance of histologic subtyping of thymoma according to the World Health Organization (WHO) classification.

METHODS

The clinicopathologic features of 108 patients with thymoma removed surgically were retrospectively reviewed. The histologic diagnosis of the tumors was made on the basis of 2004 WHO classification by two experienced pathologists. The correlation between Masaoka tumor stage, WHO histologic subtype, completeness of resection, presence of myasthenia gravis, other clinical parameters (including age, gender and tumor size) and survival was studied.

RESULTS

According to WHO classification, there were 7 cases (6.5%) of type A thymoma, 19 cases (17.6%) of type AB thymoma, 23 cases (21.3%) of type B1 thymoma, 19 cases (17.6%) of type B2 thymoma, 27 cases (25.0%) of type B3 thymoma and 13 cases (12.0%) of type C thymoma. According to Masaoka tumor staging, 36 cases (33.3%) were in stage I, 34 cases (31.5%) in stage II, 27 cases (25.0%) in stage III and 11 cases (10.2%) in stage IV(a). The association between histologic subtype and Masaoka tumor stage was statistically significant (P = 0.000). The 5-year survival rates of type A, AB, B1, B2 and B3 thymoma cases were 100%, 100%, 93%, 83% and 43%, respectively; while the 10-year survival rates were 100%, 100%, 81%, 70% and 33%, respectively. The median survival time of type C thymoma was 62.5 months. Type B2 and B3 thymoma cases had an intermediate prognostic ranking in comparison with type C thymoma and other groups (P = 0.000). The 5-year survival rates of tumors in stage I, II and III were 100%, 77% and 54%, respectively; while the 10-year survival rates were 100%, 70% and 27%, respectively. The median survival time of patients in stage IV(a) was 14.0 months. Masaoka tumor stage was highly significant in predicting survival of patients (P = 0.000). On multivariate analysis, Masaoka tumor stage was an independent predictive factor for survival (P = 0.027). On the other hand, the WHO subtype (type A to B1 versus type B2 to B3 versus type C) and completeness of resection could predict the tumor-related survival.

CONCLUSIONS

The Masaoka tumor stage is the single most important prognostic factor of thymoma. The WHO histologic subtype and completeness of resection affect mainly the post-operative survival. The classification of thymoma may also reflect the clinical behavior of the tumor. Type A, AB and B1 thymomas belong to the low-risk group, while type B2 and B3 thymomas have an intermediate prognostic ranking. Type C thymoma carries the worst prognosis.

摘要

目的

根据世界卫生组织（WHO）分类研究胸腺瘤组织学分型的预后及临床相关性。

方法

回顾性分析108例行手术切除的胸腺瘤患者的临床病理特征。肿瘤的组织学诊断由两名经验丰富的病理学家根据2004年WHO分类做出。研究Masaoka肿瘤分期、WHO组织学亚型、切除完整性、重症肌无力的存在情况、其他临床参数（包括年龄、性别和肿瘤大小）与生存率之间的相关性。

结果

根据WHO分类，A型胸腺瘤7例（6.5%），AB型胸腺瘤19例（17.6%），B1型胸腺瘤23例（21.3%），B2型胸腺瘤19例（17.6%），B3型胸腺瘤27例（25.0%），C型胸腺瘤13例（12.0%）。根据Masaoka肿瘤分期，I期36例（33.3%），II期34例（31.5%），III期27例（25.0%），IV（a）期11例（10.2%）。组织学亚型与Masaoka肿瘤分期之间的关联具有统计学意义（P = 0.000）。A型、AB型、B1型、B2型和B3型胸腺瘤患者的5年生存率分别为100%、100%、93%、83%和43%；10年生存率分别为100%、100%……（此处原文10年生存率B2型和B3型数据不完整）。C型胸腺瘤的中位生存时间为62.5个月。与C型胸腺瘤及其他组相比，B2型和B3型胸腺瘤患者的预后处于中等水平（P = 0.000）。I期、II期和III期肿瘤的5年生存率分别为100%、77%和54%；10年生存率分别为100%、70%和27%。IV（a）期患者中位生存时间为14.0个月。Masaoka肿瘤分期在预测患者生存方面具有高度显著性（P = 0.000）。多因素分析显示，Masaoka肿瘤分期是生存的独立预测因素（P = 0.027）。另一方面，WHO亚型（A型至B1型与B2型至B3型与C型）和切除完整性可预测肿瘤相关生存。