胸腺上皮肿瘤：加拿大一个地区癌症项目的12年经验

Thymic epithelial neoplasms: a 12-year Canadian regional cancer program experience.

作者信息

Wheatley-Price Paul, Jonker Hannah, Jonker Derek, Shamji Farid, Gomes Marcio M

机构信息

Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada.

Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

出版信息

Clin Lung Cancer. 2014 May;15(3):231-6. doi: 10.1016/j.cllc.2013.12.003. Epub 2013 Dec 27.

DOI:10.1016/j.cllc.2013.12.003

PMID:24485232

Abstract

BACKGROUND

Thymic epithelial neoplasms are rare, with little prospective research to guide management. Surgery is the primary treatment modality for localized disease, but chemotherapy may be indicated in advanced disease. We performed a retrospective chart review of all cases over a 12-year period at our institution.

PATIENTS AND METHODS

With ethics approval, data collected included patient characteristics, histologic type (World Health Organization [WHO] criteria), staging (Masaoka system), paraneoplastic syndromes, treatment details, and outcomes. The primary analysis is descriptive.

RESULTS

Thymic epithelial neoplasms were identified in 76 patients: 46% women with a median age 60 years (range, 25-89 years), 93% with Eastern Cooperative Oncology Group performance status of 0 to 1. Myasthenia gravis was present in 21%. The distribution by WHO histologic classification was A, 15%; AB, 30%; B1, 16%; B2, 13%; B3, 17%; C, 7%; neuroendocrine thymic tumor (NETT), 1%; and unclassified, 1%. Of 64 patients who underwent operation, 53 underwent R0 resection. Eleven surgical patients received chemotherapy (induction, n = 6; adjuvant, n = 4; both, n = 1) and 27 received radiotherapy (induction, n = 2; adjuvant, n = 25). Twelve patients were not considered for surgery, and 3 patients received no therapy at all. Chemotherapy was received at some point in the disease course in 14 patients. Common first-line regimens were platinum/etoposide (n = 8), carboplatin/paclitaxel (n = 3), and CAP (cyclophosphamide, doxorubicin [Adriamycin], cisplatin [n = 2]). The first-line response rate (Response Evaluation in Solid Tumors [RECIST]) was 55%. After a median follow-up of 45 months, 59 (78%) patients remain alive. Thymoma was associated with superior overall survival compared with thymic carcinoma (P < .0001).

CONCLUSION

Although surgical resection is the mainstay of treatment for thymic epithelial neoplasms, it remains clear that these are chemosensitive diseases.

摘要

背景

胸腺上皮肿瘤较为罕见，前瞻性研究较少，难以指导治疗。手术是局限性疾病的主要治疗方式，但晚期疾病可能需要化疗。我们对本机构12年间的所有病例进行了回顾性病历审查。

患者与方法

经伦理批准，收集的数据包括患者特征、组织学类型（世界卫生组织[WHO]标准）、分期（Masaoka系统）、副肿瘤综合征、治疗细节及结果。主要分析为描述性分析。

结果

共识别出76例胸腺上皮肿瘤患者：女性占46%，中位年龄60岁（范围25 - 89岁），93%的东部肿瘤协作组体能状态为0至1。21%的患者合并重症肌无力。按WHO组织学分类分布为：A型占15%；AB型占30%；B1型占16%；B2型占13%；B3型占17%；C型占7%；神经内分泌胸腺肿瘤（NETT）占1%；未分类占1%。64例接受手术的患者中，53例实现R0切除。11例手术患者接受了化疗（诱导化疗，n = 6；辅助化疗，n = 4；两者皆有，n = 1），27例接受了放疗（诱导放疗，n = 2；辅助放疗，n = 25）。12例患者未考虑手术，3例患者未接受任何治疗。14例患者在病程中的某个阶段接受了化疗。常见的一线方案为铂类/依托泊苷（n = 8）、卡铂/紫杉醇（n = 3）以及CAP方案（环磷酰胺、阿霉素[阿霉素]、顺铂[n = 2]）。一线缓解率（实体瘤疗效评价标准[RECIST]）为55%。中位随访45个月后，59例（78%）患者仍存活。胸腺瘤的总生存率高于胸腺癌（P < .0001）。