Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Ann Thorac Surg. 2012 Jun;93(6):1822-8; discussion 1828-9. doi: 10.1016/j.athoracsur.2012.03.004. Epub 2012 May 1.
Because of the rarity of the disease and long survival of most patients, the role of adjuvant radiation therapy in patients with surgically resected stage III thymoma is unclear, and few prospective studies are available. The objective was to evaluate the impact of postoperative radiation therapy after resection of stage III thymoma.
The Surveillance, Epidemiology, and End Results (SEER) database was queried for all patients with stage III thymoma who underwent surgical therapy and survived more than 30 days after diagnosis. Survival was estimated with the Kaplan-Meier method. The hazard ratio for death was determined using a Cox proportional hazard model.
There were 476 patients with stage III thymoma identified who underwent surgical therapy, did not receive preoperative radiotherapy, and had complete SEER records with regard to radiation treatment. Postoperative radiation therapy was given to 322 patients (67.6%). Patients who received postoperative radiation therapy were younger and had a higher rate of debulking surgery than patients who did not. Patients receiving postoperative radiation had a median overall survival of 127 months (95% confidence interval, 100.9 to 153.1) compared with 105 months (95% confidence interval, 76.9 to 133.1) in patients treated with surgery alone (p=0.038). However, in multivariate analysis, postoperative radiation was not a significant factor affecting overall survival. Disease-specific survival was significantly improved in the adjuvant radiation group, and in multivariate analysis, improved outcomes were associated with postoperative radiation (p=0.049).
In this large population-based study, most patients with stage III thymoma were treated with adjuvant radiation. Postoperative radiation was associated with improved disease-specific survival, but not improved overall survival.
由于该病罕见，且大多数患者生存时间较长，因此术后辅助放疗在 III 期胸腺瘤患者中的作用尚不清楚，且可用的前瞻性研究较少。本研究旨在评估 III 期胸腺瘤切除术后放疗的效果。
本研究通过检索接受手术治疗且诊断后存活时间超过 30 天的 III 期胸腺瘤患者的监测、流行病学和最终结果（SEER）数据库，评估了术后放疗对 III 期胸腺瘤患者的影响。使用 Kaplan-Meier 法估计生存率，Cox 比例风险模型确定死亡风险的风险比。
共纳入 476 例接受手术治疗、未接受术前放疗且 SEER 记录完整的 III 期胸腺瘤患者。术后放疗共 322 例（67.6%）。与未接受术后放疗的患者相比，接受术后放疗的患者年龄更小，接受的肿瘤减灭术比例更高。术后放疗组的中位总生存时间为 127 个月（95%置信区间，100.9-153.1），而单纯手术组为 105 个月（95%置信区间，76.9-133.1）（p=0.038）。然而，多因素分析显示，术后放疗不是影响总生存的显著因素。辅助放疗组的疾病特异性生存率显著提高，多因素分析显示，术后放疗与疾病特异性生存率的提高有关（p=0.049）。
在这项大型基于人群的研究中，大多数 III 期胸腺瘤患者接受了辅助放疗。术后放疗与改善的疾病特异性生存率相关，但与总生存率的改善无关。
