单中心 40 年复发胸腺瘤再手术的结果。

Single-centre 40-year results of redo operation for recurrent thymomas.

机构信息

Department of General Thoracic Surgery, Catholic University, Rome, Italy.

出版信息

Eur J Cardiothorac Surg. 2011 Oct;40(4):894-900. doi: 10.1016/j.ejcts.2011.01.025. Epub 2011 Feb 25.

DOI:10.1016/j.ejcts.2011.01.025

PMID:21353790

Abstract

OBJECTIVE

Modes of treatment for recurrent thymoma remain controversial. The aim of this study is to analyse the early and long-term results of surgical intervention for this condition.

METHODS

Between 1972 and 2008, 43 out of 315 patients, who underwent resection with radical intent for thymoma, subsequently relapsed. Of these, 30 cases were deemed suitable for resection and operation, and were surgically treated. The remaining 13 were treated with radio- and/or chemotherapy (RT/CT). Overall outcomes for long-term survival up to 5 years (LTS) and disease-free survival (DFS) were analysed using standard statistics.

RESULTS

The average age of the relapsed patients was 54.7±12.7 years. There were 21 males and 22 females. Forty out of the 43 had myasthenia gravis (MG). Fifteen cases concerned a single detected relapse lesion. Among the 43 patients, relapses were found in the following sites: pleura (25 cases), mediastinum (12), lung (five), liver and bone (one). The perioperative mortality was 0% and the morbidity was 27%. Twenty-two of the surgically treated patients had complete resection; their LTS was 77% and DFS was 71%. Those patients who underwent surgery had significantly better outcomes compared with patients treated with radio- and/or chemotherapy (LTS only 35%; hazard ratio (HR): 0.22; 95% confidence interval (CI): 0.08-0.59; p=0.001). Complete repeated resection yielded much better outcomes than partial resection (LTS 91% vs 31%, p<0.001), whereas incomplete resection was associated, as one might expect, with a poor prognosis (HR: 6.12; 95% CI: 1.18-31.55; p=0.031). No evidence for an association with other clinical, surgical and pathological characteristics was found with regard to LTS or DFS.

CONCLUSIONS

Surgical resection is recommended for the treatment of recurrent thymoma, provided that criteria for suitability for resection/operation are satisfactory at the time of diagnosis. Best survival outcomes are found to depend on the degree of completeness of the repeat resection.

摘要

目的

复发性胸腺瘤的治疗方式仍存在争议。本研究旨在分析此类疾病的手术干预的早期和长期结果。

方法

1972 年至 2008 年间，315 例胸腺瘤患者接受根治性切除术，其中 43 例患者随后复发。其中 30 例患者认为适合再次手术切除，接受了手术治疗。其余 13 例患者接受了放化疗（RT/CT）。采用标准统计学方法分析 5 年总生存率（LTS）和无病生存率（DFS）的长期结果。

结果

复发性患者的平均年龄为 54.7±12.7 岁。男性 21 例，女性 22 例。43 例中有 40 例患有重症肌无力（MG）。15 例为单发复发病灶。43 例患者中，复发部位如下：胸膜（25 例）、纵隔（12 例）、肺（5 例）、肝和骨（1 例）。围手术期死亡率为 0%，发病率为 27%。22 例手术治疗患者完全切除，其 LTS 为 77%，DFS 为 71%。与接受放化疗的患者相比，接受手术治疗的患者预后明显更好（LTS 仅为 35%；风险比（HR）：0.22；95%置信区间（CI）：0.08-0.59；p=0.001）。完全重复切除的疗效明显优于部分切除（LTS 分别为 91%和 31%，p<0.001），而不完全切除则与预后不良相关（HR：6.12；95% CI：1.18-31.55；p=0.031）。在 LTS 或 DFS 方面，未发现与其他临床、手术和病理特征有关的证据。