局部晚期胸腺瘤和胸腺癌（Masaoka 分期 III 和 IVa）患者的生存预测因素。

Predictors of survival in patients with locally advanced thymoma and thymic carcinoma (Masaoka stages III and IVa).

机构信息

Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo-Forlanini, Via Portuense 332, 00149 Rome, Italy.

出版信息

Eur J Cardiothorac Surg. 2010 Apr;37(4):819-23. doi: 10.1016/j.ejcts.2009.11.001. Epub 2009 Nov 30.

DOI:10.1016/j.ejcts.2009.11.001

PMID:19948412

Abstract

OBJECTIVE

We sought to evaluate factors influencing long-term survival of patients with locally advanced thymoma/thymic carcinoma (Masaoka stages III and IVa) treated by immediate surgery or induction therapy plus surgery.

METHODS

From January 1991 to April 2007, we surgically treated 61 patients with locally advanced thymoma/thymic carcinoma (Masaoka stages III and IVa). Staging included total body computed tomography (CT) scan in all patients, and chest magnetic resonance imaging (MRI) in 27 selected patients. All patients had histological confirmation before surgery. Thirty-one patients (group A) underwent induction chemotherapy followed by surgery. Thirty patients (group B) underwent immediate surgery. Thirty-four patients (group A: 13; group B: 17) received postoperative radiation therapy.

RESULTS

No intra-operative mortality was reported. World Health Organization (WHO) histological classification included 19 AB, four B1, seven B2 and 13 B3 thymomas and 18 thymic carcinomas. Thirty-four patients were Masaoka stage III (group A: 18; group B: 16) and 27 patients were stage IVa (group A: 13; group B: 14). After a median follow-up of 77 months, six patients of group A and seven patients of group B died of disease. The overall 10-year survival rate was 50.6%. The 10-year survival rate was 57.9% in group A and 38.1% in group B (p=0.03). Multivariate analysis showed complete resection (p=0.02), Masaoka stage (III vs IVa) (p=0.02), induction chemotherapy (group A vs group B) (p=0.003) and histological WHO subtype (AB vs B1, B2 and B3) (p=0.01) to be statistically significant independent predictors of survival. Sex, age and adjuvant radiation therapy showed no statistically significant difference.

CONCLUSIONS

Complete resection, Masaoka stage, induction chemotherapy and histological WHO classification showed to be independent predictors of survival in locally advanced thymoma/thymic carcinoma.

摘要

目的

评估接受即刻手术或诱导治疗加手术的局部晚期胸腺瘤/胸腺癌（Masaoka 分期 III 和 IVa 期）患者的长期生存的影响因素。

方法

1991 年 1 月至 2007 年 4 月，我们对 61 例局部晚期胸腺瘤/胸腺癌（Masaoka 分期 III 和 IVa 期）患者进行了手术治疗。所有患者均行全身计算机断层扫描（CT）检查，27 例患者选择性行胸部磁共振成像（MRI）检查。所有患者均在术前获得组织学证实。31 例患者（A 组）接受诱导化疗后行手术治疗。30 例患者（B 组）立即手术。34 例患者（A 组：13 例；B 组：17 例）接受术后放疗。

结果

无术中死亡。世界卫生组织（WHO）组织学分类包括 19 例 AB、4 例 B1、7 例 B2 和 13 例 B3 胸腺瘤和 18 例胸腺癌。34 例患者为 Masaoka 分期 III 期（A 组：18 例；B 组：16 例），27 例患者为 IVa 期（A 组：13 例；B 组：14 例）。中位随访 77 个月后，A 组 6 例和 B 组 7 例患者死于疾病。总的 10 年生存率为 50.6%。A 组的 10 年生存率为 57.9%，B 组为 38.1%（p=0.03）。多因素分析显示完全切除（p=0.02）、Masaoka 分期（III 期 vs IVa 期）（p=0.02）、诱导化疗（A 组 vs B 组）（p=0.003）和组织学 WHO 亚型（AB 与 B1、B2 和 B3）（p=0.01）是生存的统计学显著独立预测因素。性别、年龄和辅助放疗无统计学差异。