胸腺瘤扩大性胸腺切除术的生存情况。

Survival after extended thymectomy for thymoma.

机构信息

Department of Thoracic Surgery, University of Tokyo, Tokyo, Japan.

出版信息

Eur J Cardiothorac Surg. 2012 Mar;41(3):623-7. doi: 10.1093/ejcts/ezr026. Epub 2011 Oct 18.

DOI:10.1093/ejcts/ezr026

PMID:22011779

Abstract

OBJECTIVES

Thymoma is a relatively rare tumour and is uniquely associated with autoimmune diseases such as myasthenia gravis (MG). However, the factors involved in the prognosis of thymoma remain under discussion.

METHODS

We retrospectively reviewed 162 patients who underwent extended thymectomy via median sternotomy for thymoma at our institute from 1976 to 2009. The histological subtype was classified according to the World Health Organization (WHO) histological classification system. Survival analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model.

RESULTS

Tumours comprised 7 Type A tumours, 38 Type AB, 49 Type B1, 45 Type B2 and 23 Type B3. Various types of autoimmune diseases were comorbid in 66 patients. The median follow-up period was 94 months, and 14 patients experienced recurrence. Seven patients died of recurrent tumour, and 18 patients died of causes other than thymoma. The 10-year overall survival was 85.7%, and the 10-year disease-free survival (DFS) was 76.8%. The 10-year DFS was 62.5% for Type A, 86.3% for Type AB, 91.5% for Type B1, 77.1% for Type B2 and 26.3% for Type B3. In multivariate analysis, age, Type B3 and MG were determined as prognostic factors for survival. On the other hand, Masaoka's stage did not influence survival.

CONCLUSIONS

Type B3 classified by the WHO histological classification system is a poor prognostic factor for survival of thymoma after extended thymectomy. Association with MG is possibly an indicator of poor survival. Age is an independent prognostic factor, suggesting favourable prognosis of thymoma after surgical treatment. Considering thymoma is a rare tumour, it would be necessary to build a multi-institutional database as soon as possible.

摘要

目的

胸腺瘤是一种相对罕见的肿瘤，与重症肌无力（MG）等自身免疫性疾病密切相关。然而，胸腺瘤预后的相关因素仍存在争议。

方法

我们回顾性分析了 1976 年至 2009 年在我院接受正中胸骨切开术扩大胸腺切除术的 162 例胸腺瘤患者。组织学亚型根据世界卫生组织（WHO）组织学分类系统进行分类。采用 Kaplan-Meier 法和 Cox 比例风险模型进行生存分析。

结果

肿瘤包括 7 型 A 肿瘤、38 型 AB、49 型 B1、45 型 B2 和 23 型 B3。66 例患者合并各种类型的自身免疫性疾病。中位随访时间为 94 个月，14 例患者复发。7 例患者死于复发性肿瘤，18 例患者死于非胸腺瘤原因。10 年总生存率为 85.7%，10 年无病生存率（DFS）为 76.8%。A型的 10 年 DFS 为 62.5%，AB 型为 86.3%，B1 型为 91.5%，B2 型为 77.1%，B3 型为 26.3%。多因素分析显示，年龄、B3 型和 MG 是影响生存的预后因素。另一方面，Masaoka 分期对生存没有影响。