Department of Radiation Oncology, University of Washington, Seattle, Washington, USA.
Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):1797-801. doi: 10.1016/j.ijrobp.2011.03.010. Epub 2011 May 17.
The management of patients diagnosed with thymoma remains unclear. This report attempts to identify the impact of adjuvant radiotherapy on overall survival (OS) and cause-specific survival (CSS) in patients diagnosed with thymoma.
Patients diagnosed with thymic malignancy between 1973 and 2003 were retrospectively identified from centers participating in the Surveillance, Epidemiology, and End Results (SEER) program. Those patients classified as having thymic carcinoma were excluded from this analysis. OS and CSS were estimated by the Kaplan-Meier method. Outcomes for patients treated with and without radiation therapy were compared using the log-rank test. Multivariate analysis was performed with the Cox proportional hazards model to analyze factors predictive of OS and CSS.
A total of 1,464 patients were identified as having thymic malignancy, and of these, 1,254 patients were identified as having malignant thymoma. The median follow-up time was 41 months (range, 4-337 months). Among patients who did not receive radiotherapy (RT), the 10-year rate of OS was 41% compared to 42% for those who did receive RT (p = 0.06). The median OS for the patients who did not receive RT was 80 months compared to 97 months for those who did receive RT. In patients with Masaoka stage II-III malignancy, OS was significantly improved with RT (p = 0.002), and a trend in improved CSS was observed (p = 0.1). Patients were also analyzed based on resection status. For those patients who had an incomplete excision, the 10-year OS was 63% with RT and 46% without RT (p = 0.38). On multivariate analysis, factors predictive of OS included age, extent of surgery, stage, and number of lymph nodes examined.
This study reports treatment results of a large cohort of patients who were diagnosed with malignant thymoma. This study demonstrates that the use of RT following resection for thymoma significantly improves OS for those with regional disease and marginally improves CSS.
胸腺瘤患者的治疗管理仍不明确。本报告试图确定辅助放疗对胸腺瘤患者的总生存率（OS）和特定病因生存率（CSS）的影响。
从参与监测、流行病学和最终结果（SEER）计划的中心回顾性确定 1973 年至 2003 年间诊断为胸腺恶性肿瘤的患者。排除了将这些患者归类为胸腺癌的患者。使用 Kaplan-Meier 法估计 OS 和 CSS。使用对数秩检验比较接受和未接受放射治疗的患者的结果。使用 Cox 比例风险模型进行多变量分析，以分析预测 OS 和 CSS 的因素。
共确定了 1464 例患有胸腺恶性肿瘤的患者，其中 1254 例被确定为患有恶性胸腺瘤。中位随访时间为 41 个月（范围，4-337 个月）。在未接受放疗（RT）的患者中，10 年 OS 率为 41%，而接受 RT 的患者为 42%（p=0.06）。未接受 RT 的患者的中位 OS 为 80 个月，而接受 RT 的患者为 97 个月。在 Masaoka 分期 II-III 期恶性肿瘤患者中，RT 显著改善了 OS（p=0.002），并且观察到 CSS 改善的趋势（p=0.1）。患者还根据切除状态进行分析。对于那些不完全切除的患者，RT 组的 10 年 OS 为 63%，无 RT 组为 46%（p=0.38）。多变量分析表明，OS 的预测因素包括年龄、手术范围、分期和检查的淋巴结数量。
本研究报告了大量诊断为恶性胸腺瘤患者的治疗结果。本研究表明，对于局部疾病和边缘性 CSS 患者，切除后使用 RT 显著提高了 OS。
