Yang Yu, Fan Xing-Wen, Wang Hong-Bing, Xu Yin, Li Dou-Dou, Wu Kai-Liang
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
BMC Cancer. 2017 Mar 27;17(1):217. doi: 10.1186/s12885-017-3228-2.
This study aimed to analyze the pattern of lymphogenous and hematogenous metastases in patients with stage IVb thymic carcinomas and identify prognostic factors for their survivals.
Between September 1978 and October 2014, 68 patients with pathologically confirmed stage IVb thymic carcinomas were treated at Fudan University Shanghai Cancer Center. Forty-three patients had lymph node involvement without distant metastases, and the remaining 25 patients had hematogenous metastases. Clinical-pathological characteristics, including age, sex, histologic subtype, tumor size, metastasis, treatment modalities, such as surgical resection, radiotherapy, and chemotherapy, and clinical outcomes, such as overall survival (OS) and progression free survival (PFS), were analyzed.
The median follow-up time was 22 months (range, 1-126 months). The median OS of all patients with stage IVb thymic carcinomas was 30 months, and the 5-year overall survival rate was 25.1%. The median PFS was 11 months, and the 5-year PFS was 17.9%. Stage IVb patients with lymph node involvement had a better survival than those with distant metastasis (40 vs. 20 months, p = 0.002). Patients with myasthenia gravis had a worse prognosis (p = 0.033). Multivariate analysis identified metastatic status as an independent prognostic factor for OS in patients with stage IVb thymic carcinomas.
Patients with lymph node involvement had a better survival than those with distant metastases. Much work remains to investigate the prognosis of patients with stage IVb thymic carcinomas and to explore different treatment strategies for patients with lymph node involvement and distant metastases.
本研究旨在分析IVb期胸腺癌患者的淋巴道转移和血行转移模式，并确定其生存的预后因素。
1978年9月至2014年10月期间，复旦大学附属肿瘤医院对68例经病理确诊的IVb期胸腺癌患者进行了治疗。43例患者有淋巴结转移但无远处转移，其余25例患者有血行转移。分析了患者的临床病理特征，包括年龄、性别、组织学亚型、肿瘤大小、转移情况、治疗方式（如手术切除﹑放疗和化疗）以及临床结局（如总生存期（OS）和无进展生存期（PFS））。
中位随访时间为22个月（范围1 - 126个月）。所有IVb期胸腺癌患者的中位OS为30个月，5年总生存率为25.1%。中位PFS为11个月，5年PFS为17.9%。有淋巴结转移的IVb期患者的生存期优于有远处转移的患者（40个月对20个月，p = 0.002）。患有重症肌无力的患者预后较差（p = 0.033）。多因素分析确定转移状态是IVb期胸腺癌患者OS的独立预后因素。
有淋巴结转移的患者比有远处转移的患者生存期更好。对于IVb期胸腺癌患者预后的研究以及探索针对有淋巴结转移和远处转移患者的不同治疗策略仍有许多工作要做。
