Dango Sebastian, Passlick Bernward, Thiemann Ulf, Kayser Gian, Stremmel Christian
Clinic for Thoracic Surgery, Hugstetter Str, 55, University Hospital Freiburg, Albert-Ludwig-University, 79106 Freiburg, Germany.
J Cardiothorac Surg. 2009 Jul 15;4:33. doi: 10.1186/1749-8090-4-33.
Treatment of thymoma is often based on observation of only a few patients. Surgical resection is considered to be the most important step. Role of a pseudocapsula for surgery, its clinical significance and outcome compared with established prognostic parameters is discussed which has not been reported so far.
84 patients with thymoma underwent resection and analysis was carried out for clinical features, prognostic factors and long-term survival.
Fifteen patients were classified in WHO subgroup A, 21 in AB, 29 in B and 19 patients in C. Forty two patients were classified in Masaoka stage I, 19 stage II, 9 stage III and 14 stage IV. Encapsulated thymoma was seen in 40, incomplete or missing capsula in 44 patients. In 71 complete resections, local recurrence was 5%. 5-year survival was 88.1%. Thymomas with pseudocapsula showed a significant better survival (94.9% vs. 61.1%, respectively) (p = 0.001) and was correlated with the absence of nodal or distant metastasis (p = 0.04 and 0.001, respectively). Presence of pseudocapsula as well as the Masaoka and WHO classification, and R-status were of prognostic significance. R-status and Masaoka stage appeared to be of independent prognostic significance in multivariate analysis.
Intraoperative presence of an encapsulated tumor is a good technical marker for the surgeon to evaluate resectability and estimate prognosis. Although the presence of a capsula is of strong significance in the univariate analysis, it failed in the multivariate analysis due to its correlation with clinical Masaoka stage. Masaoka stage has a stronger relevance than WHO classification to determinate long-term outcome.
胸腺瘤的治疗通常仅基于少数患者的观察结果。手术切除被认为是最重要的步骤。本文讨论了假包膜在手术中的作用、其临床意义以及与既定预后参数相比的结果，这些内容迄今尚未见报道。
84例胸腺瘤患者接受了切除术，并对临床特征、预后因素和长期生存情况进行了分析。
15例患者属于世界卫生组织（WHO）A亚组，21例属于AB亚组，29例属于B亚组，19例属于C亚组。42例患者为Masaoka I期，19例为II期，9例为III期，14例为IV期。40例可见包膜完整的胸腺瘤，44例包膜不完整或缺失。在71例完整切除病例中，局部复发率为5%。5年生存率为88.1%。有假包膜的胸腺瘤生存率显著更高（分别为94.9%和61.1%）（p = 0.001），且与无淋巴结或远处转移相关（分别为p = 0.04和0.001）。假包膜的存在以及Masaoka和WHO分类以及R状态具有预后意义。在多因素分析中，R状态和Masaoka分期似乎具有独立的预后意义。
术中存在包膜完整的肿瘤是外科医生评估可切除性和估计预后的良好技术指标。尽管包膜的存在在单因素分析中具有重要意义，但由于其与临床Masaoka分期相关，在多因素分析中未显示出意义。Masaoka分期在确定长期预后方面比WHO分类具有更强的相关性。
