Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2012 Jul;94(1):247-54; discussion 254. doi: 10.1016/j.athoracsur.2012.02.092. Epub 2012 May 26.
There are few data on outcomes after surgical treatment for recurrent thymic tumors. The aim of this study is to analyze and compare long-term outcomes of treatments for recurrent thymic tumors.
Between January 1956 and December 2009, 344 thymic tumors were surgically resected (309 thymomas, 22 thymic carcinomas, 12 thymic carcinoids, and 1 thymolipoma). There were 48 recurrences (13.9%): 30 thymomas, 9 thymic carcinomas, and 9 thymic carcinoids. There were 27 men and 21 women with a median age of 51 years (range, 27 to 83). Retrospective chart review was performed. Relevant factors for recurrence as well as survival and progression-free interval were analyzed.
The median follow-up interval from the initial operation was 83 months (range, 9 to 515). Recurrence adversely affected overall survival in surgically resected thymic tumors (p = 0.0014). In multivariate analysis, the initial Masaoka stage, incomplete resection, and World Health Organization histology were significant risk factors for recurrence. In multivariate analysis, only surgical management was associated with prolonged survival p = 0.0038) and improved progression-free interval (p = 0.0378) in recurrent thymoma. Five-year survival after recurrent thymoma was 54%. For recurrent thymic carcinoma, surgery did not improve survival. For these patients, chemotherapy was associated with improved progression-free interval after recurrence (p = 0.0295). There were no 5-year survivors of recurrent thymic carcinoma.
Our data suggest that surgical management is associated with better outcome and is the treatment of choice for recurrent thymoma. For recurrent thymic carcinoma, surgical management has a very limited role, and chemotherapy appears to be a more effective treatment modality.
关于胸腺瘤术后复发的治疗结果数据较少。本研究旨在分析和比较复发性胸腺瘤的治疗结果。
1956 年 1 月至 2009 年 12 月期间，共手术切除了 344 例胸腺瘤（309 例胸腺瘤、22 例胸腺癌、12 例胸腺癌、1 例胸腺脂肪瘤）。有 48 例复发（13.9%）：30 例胸腺瘤、9 例胸腺癌和 9 例胸腺癌。有 27 名男性和 21 名女性，中位年龄为 51 岁（范围，27 至 83 岁）。对病历进行了回顾性分析。分析了复发及生存和无进展间隔的相关因素。
从初始手术开始的中位随访时间为 83 个月（范围，9 至 515）。复发对胸腺瘤的总生存有不良影响（p = 0.0014）。多变量分析显示，初始 Masaoka 分期、不完全切除和世界卫生组织组织学是复发的显著危险因素。多变量分析显示，只有手术治疗与延长生存（p = 0.0038）和改善无进展间隔（p = 0.0378）有关。复发性胸腺瘤的 5 年生存率为 54%。对于复发性胸腺癌，手术并不能改善生存。对于这些患者，化疗与复发后无进展间隔的改善有关（p = 0.0295）。没有复发性胸腺癌的 5 年生存者。
我们的数据表明，手术治疗与更好的结果相关，是复发性胸腺瘤的首选治疗方法。对于复发性胸腺癌，手术治疗的作用非常有限，化疗似乎是一种更有效的治疗方法。
