B 型胸腺瘤：预后仅能由世界卫生组织分类预测吗？

Type B thymoma: is prognosis predicted only by World Health Organization classification?

机构信息

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

J Thorac Cardiovasc Surg. 2010 Jun;139(6):1431-1435.e1. doi: 10.1016/j.jtcvs.2009.10.024. Epub 2009 Dec 28.

DOI:10.1016/j.jtcvs.2009.10.024

PMID:20038470

Abstract

OBJECTIVE

The prognostic relevance of subtypes within type B thymomas is controversial. The objective of this study was to evaluate the utility of World Health Organization (WHO) classification in patients with type B thymoma.

METHODS

This was a retrospective review of 100 patients who underwent thymectomy for WHO type B thymoma. Recurrence patterns and survival were compared among subtypes.

RESULTS

There were 22 type B1 tumors, 43 type B2 tumors, and 35 type B3 tumors. Incomplete resection occurred in 5 patients with type B1 thymoma, 8 with type B2 thymoma, and 8 with type B3 thymoma (P = .87). Of the 79 patients with complete resection, tumor recurrence occurred in 1 (5.9%) patient with type B1 thymoma, 2 (5.7%) with type B2 thymoma, and 2 (7.4%) with type B3 thymoma, and all of these patients had Masaoka stage III disease. Disease-free survival at 5 years was 93%, 85%, and 82% in type B1, B2, and B3, respectively (B1 vs B2; P = .79; B2 vs B3; P = 0.6). Disease-free survival at 5 years was 94%, 100%, 61%, and 50% in Masaoka stages I, II, III, and IV, respectively (I vs II; P = .26; II vs III; P = .028; III vs IV; P = .002).

CONCLUSIONS

Tumor recurrence was significantly associated with advanced Masaoka stage regardless of the WHO subtype of type B thymomas. Given the heterogeneity of WHO type B thymomas, Masaoka stage should always be considered when predicting prognosis and planning adjuvant treatment for patients with type B thymomas.

摘要

目的

B 型胸腺瘤内亚型的预后相关性存在争议。本研究的目的是评估世界卫生组织（WHO）分类在 B 型胸腺瘤患者中的应用价值。

方法

这是一项回顾性研究，共纳入 100 例接受胸腺切除术的 WHO 型 B 胸腺瘤患者。比较了不同亚型之间的复发模式和生存情况。

结果

22 例为 B1 型肿瘤，43 例为 B2 型肿瘤，35 例为 B3 型肿瘤。B1 型胸腺瘤中有 5 例患者不完全切除，B2 型胸腺瘤中有 8 例，B3 型胸腺瘤中有 8 例（P =.87）。在 79 例完全切除的患者中，B1 型胸腺瘤中有 1 例（5.9%）、B2 型胸腺瘤中有 2 例（5.7%）、B3 型胸腺瘤中有 2 例（7.4%）出现肿瘤复发，且所有这些患者均为 Masaoka Ⅲ期疾病。B1、B2 和 B3 型肿瘤的 5 年无病生存率分别为 93%、85%和 82%（B1 与 B2；P =.79；B2 与 B3；P = 0.6）。Masaoka Ⅰ、Ⅱ、Ⅲ和Ⅳ期的 5 年无病生存率分别为 94%、100%、61%和 50%（Ⅰ与Ⅱ；P =.26；Ⅱ与Ⅲ；P =.028；Ⅲ与Ⅳ；P =.002）。