胸腺肿瘤的组织学诊断预处理活检及诱导治疗
Pretreatment biopsy for histological diagnosis and induction therapy in thymic tumors.
作者信息
Yue Jie, Gu Zhitao, Yu Zhentao, Zhang Hongdian, Ma Zhao, Liu Yuan, Fang Wentao
机构信息
1 Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200030, China.
出版信息
J Thorac Dis. 2016 Apr;8(4):656-64. doi: 10.21037/jtd.2016.03.04.
BACKGROUND
This study was to investigate the value of pretreatment biopsy for histological diagnosis and induction therapies in the management of locally advanced thymic malignancies.
METHODS
The clinical pathological data of patients with thymic tumors in the Chinese Alliance for Research in Thymomas (ChART) who underwent biopsy before treatment from 1994 to December 2012 were retrospectively reviewed. The application trend of preoperative histological diagnosis and its influence on treatment outcome were analyzed.
RESULTS
Of 1,902 cases of thymic tumors, 336 (17.1%) had undergone biopsy for histological diagnosis before therapeutic decision was decided. In recent years, percentage of pretreatment histological diagnosis significantly increased in the later ten years than the former during the study period (P=0.008). There was also a significant increase in thoracoscopy/mediastinoscopy/E-BUS biopsy as compared to open biopsy (P=0.029). Survival in Patients with preoperative biopsy for histology had significantly higher stage lesions (P=0.000) and higher grade malignancy (P=0.000), thus a significantly lower complete resection rate (P=0.000) and therefore a significantly worse survival than those without preoperative biopsy (P=0.000). In the biopsied 336 patients, those who received upfront surgery had significantly better survival than those received surgery after induction therapy (P=0.000). In stage III and IVa diseases, the R0 resection rate after induction therapies increased significantly as compared to the surgery upfront cases (65.5% vs. 46.2%, P=0.025). Tumors downstaged after induction had similar outcomes as those having upfront surgery (92.3% vs. 84.2%, P=0.51). However, tumors not downstaged by induction had significantly worse prognosis than those downstaged (P=0.004), and fared even worse than those having definitive chemoradiation without surgery (37.2% vs. 62.4%, P=0.216).
CONCLUSIONS
It is crucial to get histological diagnosis for thymoma before surgery or adjuvant treatment and minimally invasive biopsy should be undertaken. Although in our study we could not find the benefit of induction chemotherapy before surgery in survival and recurrence rate, it could increase the R0 resection rate compared with direct surgery in late stage (III and IVa).
背景
本研究旨在探讨治疗前活检在局部晚期胸腺恶性肿瘤组织学诊断及诱导治疗中的价值。
方法
回顾性分析1994年至2012年12月期间中国胸腺瘤研究联盟（ChART）中接受治疗前活检的胸腺肿瘤患者的临床病理资料。分析术前组织学诊断的应用趋势及其对治疗结果的影响。
结果
在1902例胸腺肿瘤病例中，336例（17.1%）在决定治疗方案前接受了活检以进行组织学诊断。近年来，在研究期间，治疗前组织学诊断的百分比在后十年比前十年显著增加（P=0.008）。与开放活检相比，胸腔镜/纵隔镜/E-BUS活检也显著增加（P=0.029）。术前进行组织学活检的患者生存期中病变分期显著更高（P=0.000），恶性程度更高（P=0.000），因此完全切除率显著更低（P=0.000），生存情况也显著比未进行术前活检的患者更差（P=0.000）。在336例接受活检的患者中，直接接受手术的患者生存情况显著优于接受诱导治疗后再手术的患者（P=0.000）。在III期和IVa期疾病中，与直接手术相比，诱导治疗后的R0切除率显著提高（65.5%对46.2%，P=0.025）。诱导后分期降低的肿瘤与直接手术的肿瘤预后相似（92.3%对84.2%，P=0.51）。然而，未通过诱导降低分期的肿瘤预后比分期降低的肿瘤显著更差（P=0.004），甚至比那些未手术仅接受确定性放化疗的肿瘤更差（37.2%对62.4%，P=0.216）。
结论
在手术或辅助治疗前获得胸腺瘤的组织学诊断至关重要，应采用微创活检。尽管在本研究中我们未发现术前诱导化疗在生存和复发率方面的益处，但与晚期（III期和IVa期）直接手术相比，它可以提高R0切除率。
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