Suster S, Rosai J
Department of Pathology, Mount Sinai Medical Center, Miami Beach, Florida.
Cancer. 1991 Feb 15;67(4):1025-32. doi: 10.1002/1097-0142(19910215)67:4<1025::aid-cncr2820670427>3.0.co;2-f.
The clinicopathologic features of 60 patients with thymic carcinoma were studied. Patients ranged in age from 10 to 76 years (mean, 46), of whom 24 were females and 36 were males. Overall survival at 1, 3, and 5 years was 56.6%, 40%, and 33.3%, respectively. The following morphologic features were correlated with survival: type of tumor margins; presence or absence of a lobular growth pattern; nuclear atypia; necrosis; mitotic activity; and histologic tumor type and grade. Eighty eight percent of patients with poorly circumscribed/infiltrating neoplasms died of their tumors as compared with 16.6% of patients with well-circumscribed neoplasms (P less than 0.0000). Of patients whose tumors had mitotic counts exceeding 10/10 high-power fields (HPF), 84.3% died, as compared with 21.4% of patients with lower mitotic counts (P less than 0.0000). Of patients whose tumors showed lack of lobular growth pattern, 91.6% died, as compared with 29% of those whose tumors had a lobular growth pattern (P less than 0.0000). Finally, 84.6% of patients whose tumors displayed a high-grade histology (lymphoepithelioma-like carcinoma, small cell/neuroendocrine carcinoma, clear cell carcinoma, sarcomatid carcinoma, and anaplastic/undifferentiated carcinoma) died of tumor, as compared with 0% of patients whose tumors were of low-grade histology (well-differentiated squamous carcinoma, mucoepidermoid carcinoma, and basaloid carcinoma) (P less than 0.0000). Evaluation of the various treatment modalities used to treat these patients did not yield any statistically significant correlations with survival. Two clinically distinct groups of patients were identified: one after a relatively favorable clinical course with long survival, and one after a rapidly fatal outcome. The morphologic features of the tumors in these patients correlated well with their clinical behavior; histologic type (and the grade to which it was assigned) constituted the most reliable and important predictor of prognosis.
对60例胸腺癌患者的临床病理特征进行了研究。患者年龄范围为10至76岁（平均46岁），其中女性24例，男性36例。1年、3年和5年的总生存率分别为56.6%、40%和33.3%。以下形态学特征与生存率相关：肿瘤边缘类型；是否存在小叶状生长模式；核异型性；坏死；有丝分裂活性；以及组织学肿瘤类型和分级。肿瘤边界不清/浸润性肿瘤患者中88%死于肿瘤，而边界清楚的肿瘤患者中这一比例为16.6%（P<0.0000）。肿瘤有丝分裂计数超过10/10高倍视野（HPF）的患者中84.3%死亡，而有丝分裂计数较低的患者中这一比例为21.4%（P<0.0000）。肿瘤无小叶状生长模式的患者中91.6%死亡，而肿瘤有小叶状生长模式的患者中这一比例为29%（P<0.0000）。最后，肿瘤表现为高级别组织学类型（淋巴上皮瘤样癌、小细胞/神经内分泌癌、透明细胞癌、肉瘤样癌和间变性/未分化癌）的患者中84.6%死于肿瘤，而肿瘤为低级别组织学类型（高分化鳞状癌、黏液表皮样癌和基底样癌）的患者中这一比例为0%（P<0.0000）。对用于治疗这些患者的各种治疗方式的评估未发现与生存率有任何统计学上的显著相关性。确定了两组临床特征不同的患者：一组临床病程相对良好，生存期长；另一组预后迅速恶化。这些患者肿瘤的形态学特征与其临床行为密切相关；组织学类型（及其分级）是预后最可靠和最重要的预测指标。
