Department of Cardio-Thoracic and Vascular Sciences, Division of Thoracic Surgery, University of Padova, Italy.
Lung Cancer. 2011 Apr;72(1):68-72. doi: 10.1016/j.lungcan.2010.07.006. Epub 2010 Aug 12.
In advanced stage thymic tumors complete surgical resection is not always achievable. Although surgery remains the cornerstone of therapy, there is growing evidence that multimodality treatment increases resectability and reduces the incidence of local and systemic relapses.
Between 1980 and 2008, 75 patients with stages III (n = 51), IVA (n = 18) and IVB (n = 6) thymic tumors were treated. Twenty-six patients had A-AB-B1 and 49 B2-B3-C histotype. Thirty-eight (50.6%) patients considered not radically resectable at preoperative workup, received induction chemotherapy; postoperatively 37 (49.3%) had radiotherapy, 25 (33.3%) chemoradiotherapy and 4 (5.3%) chemotherapy.
No perioperative mortality was recorded. Sixty-one (81.3%) had complete resection (CR) and 14 (18.7%) incomplete resection (IR). CR was lower in patients who received induction chemotherapy (73.7% vs 89.2%, p = 0.02). In 11 (14.7%) cases a vascular procedure was carried out. Overall 5- and 10-year survivals were 70% and 57%, respectively. Five and 10-year tumor-related survival was 78% and 70%. Ten-year survival was better for CR vs IR resection (62% vs 28%; p = 0.003) and for type A-AB-B1 vs B2-B3-C (60% vs 53%; p = 0.03). No statistical difference was found between stage III and IV (10-year survival: 63% and 43%; p = 0.42) and induction vs no induction chemotherapy (10-year survival: 52% vs 56%; p = 0.54). At multivariate analysis CR (p = 0.001) and type A-AB-B1 (p = 0.04) were independent predictors of better survival. During follow-up, 34.4% of CR developed tumor recurrence.
Multimodality treatment of stages III and IV thymic tumors guarantees good disease control and provides high survival and acceptable recurrence rates.
在晚期胸腺癌中，完全手术切除并非总是可行。尽管手术仍然是治疗的基石，但越来越多的证据表明，多模式治疗可提高可切除性并降低局部和全身复发的发生率。
1980 年至 2008 年间，共收治了 75 例 III 期（n=51）、IVA 期（n=18）和 IVB 期（n=6）胸腺癌患者。26 例患者的组织学类型为 A-AB-B1，49 例为 B2-B3-C。38 例（50.6%）患者在术前评估时被认为无法根治性切除，接受了诱导化疗；术后 37 例（49.3%）接受了放疗，25 例（33.3%）接受了放化疗，4 例（5.3%）接受了化疗。
无围手术期死亡。61 例（81.3%）患者行完全切除术（CR），14 例（18.7%）患者行不完全切除术（IR）。接受诱导化疗的患者 CR 率较低（73.7% vs 89.2%，p=0.02）。11 例（14.7%）患者进行了血管手术。总体 5 年和 10 年生存率分别为 70%和 57%。5 年和 10 年肿瘤相关生存率分别为 78%和 70%。CR 组的 10 年生存率高于 IR 组（62% vs 28%，p=0.003），A-AB-B1 型患者的 10 年生存率高于 B2-B3-C 型（60% vs 53%，p=0.03）。III 期和 IV 期（10 年生存率：63%和 43%，p=0.42）和诱导化疗与非诱导化疗（10 年生存率：52%和 56%，p=0.54）之间无统计学差异。多因素分析显示，CR（p=0.001）和 A-AB-B1 型（p=0.04）是生存的独立预测因素。在随访期间，34.4%的 CR 患者出现肿瘤复发。
III 期和 IV 期胸腺癌的多模式治疗可保证良好的疾病控制，提供高生存率和可接受的复发率。
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