Gu Zhitao, Fu Jianhua, Shen Yi, Wei Yucheng, Tan Lijie, Zhang Peng, Han Yongtao, Chen Chun, Zhang Renquan, Li Yin, Chen Ke-Neng, Chen Hezhong, Liu Yongyu, Cui Youbing, Wang Yun, Pang Liewen, Yu Zhentao, Zhou Xinming, Liu Yangchun, Liu Yuan, Fang Wentao
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China.
Zhongguo Fei Ai Za Zhi. 2016 Jul 20;19(7):459-64. doi: 10.3779/j.issn.1009-3419.2016.07.08.
To evaluate the surgical outcomes of tumor resection with or without total thymectomy for thymic epithelial tumors (TETs) using the Chinese Alliance for Research in Thymomas (ChART) retrospective database.
Patients without preoperative therapy, who underwent surgery for early-stage (Masaoka-Koga stage I and II) tumors, were enrolled for the study. They were divided into thymectomy and thymomectomy groups according to the resection extent of the thymus. Demographic and surgical outcomes were compared between the two patients groups.
A total of 1,047 patients were enrolled, with 796 cases in the thymectomy group and 251 cases in the thymomectomy group. Improvement rate of myasthenia gravis (MG) was higher after thymectomy than after thymomectomy (91.6% vs 50.0%, P<0.001). Ten-year overall survival was similar between the two groups (90.9% after thymectomy and 89.4% after thymomectomy, P=0.732). Overall, recurrence rate was 3.1% after thymectomy and 5.4% after thymomectomy, with no significant difference between the two groups (P=0.149). Stratified analysis revealed no significant difference in recurrence rates in Masaoka-Koga stage I tumors (3.2% vs 1.4%, P=0.259). However in patients with Masaoka-Koga stage II tumors, recurrence was significantly less after thymectomy group than after thymomectomy (2.9% vs 14.5%, P=0.001).
Thymectomy, instead of tumor resection alone, should still be recommended as the surgical standard for thymic malignancies, especially for stage II tumors and those with concomitant MG.
利用中国胸腺瘤研究联盟（ChART）回顾性数据库，评估胸腺上皮肿瘤（TETs）行肿瘤切除联合或不联合全胸腺切除术的手术效果。
纳入未接受术前治疗、因早期（Masaoka-Koga 分期 I 和 II 期）肿瘤接受手术的患者。根据胸腺切除范围将其分为胸腺切除术组和胸腺肿瘤切除术组。比较两组患者的人口统计学和手术结果。
共纳入 1047 例患者，其中胸腺切除术组 796 例，胸腺肿瘤切除术组 251 例。胸腺切除术后重症肌无力（MG）的改善率高于胸腺肿瘤切除术后（91.6% 对 50.0%，P<0.001）。两组的 10 年总生存率相似（胸腺切除术后为 90.9%，胸腺肿瘤切除术后为 89.4%，P = 0.732）。总体而言，胸腺切除术后复发率为 3.1%，胸腺肿瘤切除术后为 5.4%，两组之间无显著差异（P = 0.149）。分层分析显示，Masaoka-Koga 分期 I 期肿瘤的复发率无显著差异（3.2% 对 1.4%，P = 0.259）。然而，在 Masaoka-Koga 分期 II 期肿瘤患者中，胸腺切除术组的复发率显著低于胸腺肿瘤切除术组（2.9% 对 14.5%，P = 0.001）。
对于胸腺恶性肿瘤，尤其是 II 期肿瘤和合并 MG 的患者，仍应推荐胸腺切除术而非单纯肿瘤切除术作为手术标准。
