改良的 Masaoka 分期和肿瘤大小是胸腺瘤独立的预后预测因子，改良的 Masaoka 分期优于组织病理学分类。

Modified Masaoka stage and size are independent prognostic predictors in thymoma and modified Masaoka stage is superior to histopathologic classifications.

机构信息

*Department of Laboratory Medicine & Pathology, †Division of Biomedical Statistics and Informatics, ‡Division of General Thoracic Surgery, §Division of Medical Oncology, and ‖Department of Radiation-Oncology, Mayo Clinic Rochester, Rochester, MN.

出版信息

J Thorac Oncol. 2015 Apr;10(4):691-700. doi: 10.1097/JTO.0000000000000482.

DOI:10.1097/JTO.0000000000000482

PMID:25629638

Abstract

INTRODUCTION

The prognostic value of histopathologic classifications of thymoma is debated. Problematic reproducibility might cause this controversy. We studied the prognostic significance of three histopathologic classifications of thymomas after three thoracic pathologists agreed upon thymoma subtype and invasion. We also compared the outcome to established prognostic parameters.

METHODS

Patients, surgically treated for thymic epithelial neoplasm at Mayo Clinic (1942-2008), were staged according to the modified Masaoka staging and the recently proposed staging by Moran. Three thoracic pathologists independently classified all cases according to the World Health Organization, Bernatz, and proposed Suster and Moran classification. Only thymoma that all three pathologists diagnosed as the same histopathologic subtype and extent of invasion were included in outcome analysis.

RESULTS

In 214 (proposed Suster and Moran classification), 145 (World Health Organization classification), and 120 cases (Bernatz classification), reviewers agreed upon subtype of thymoma and invasion and follow-up was available. Median follow-up time was 7.5-7.7 years (range between classifications). All histopathologic classifications were associated with overall survival (OS) and disease-free survival (p ≤ 0.0001 to p = 0.048); only Bernatz classification was independent of modified Masaoka staging associated with OS (p = 0.04). Modified Masaoka stage predicted outcome independent of all histopathologic classifications and resection status and strongly correlated with the proposed Moran stage (correlation coefficient, 0.95). Thymoma size and age were prognostic parameters for OS independent of any histopathologic classification.

CONCLUSIONS

Histopathologic classifications of thymomas are associated with prognosis but are in general not independent predictors of outcome. Modified Masaoka stage and proposed Moran staging are independent prognostic parameters for thymoma and superior to histopathologic classifications.

摘要

简介

胸腺瘤的组织病理学分类的预后价值存在争议。可能是由于可重复性问题导致了这种争议。我们研究了三位胸病理学家在达成胸腺瘤亚型和侵犯程度的共识后，对三种胸腺瘤组织病理学分类的预后意义。我们还将结果与已建立的预后参数进行了比较。

方法

在梅奥诊所（1942-2008 年）接受手术治疗的胸腺上皮肿瘤患者根据改良的 Masaoka 分期和 Moran 提出的分期进行分期。三位胸病理学家根据世界卫生组织、Bernatz 和 Suster 和 Moran 提出的分类独立对所有病例进行分类。只有当所有三位病理学家诊断为相同的组织病理学亚型和侵犯程度时，才将胸腺瘤纳入结果分析。

结果

在 214 例（提出的 Suster 和 Moran 分类）、145 例（世界卫生组织分类）和 120 例（Bernatz 分类）中，审阅者同意胸腺瘤的亚型和侵犯程度，且随访资料可用。中位随访时间为 7.5-7.7 年（分类之间）。所有组织病理学分类均与总生存率（OS）和无病生存率（DFS）相关（p ≤ 0.0001 至 p = 0.048）；仅 Bernatz 分类与 OS 独立于改良 Masaoka 分期相关（p = 0.04）。改良 Masaoka 分期独立于所有组织病理学分类和切除状态预测预后，与 Moran 提出的分期高度相关（相关系数为 0.95）。胸腺瘤大小和年龄是 OS 的独立预后参数，与任何组织病理学分类无关。