胸腺肿瘤伴胸膜侵犯的外科治疗：欧洲胸外科协会胸腺肿瘤工作组项目。
Surgical therapy of thymic tumours with pleural involvement: an ESTS Thymic Working Group Project.
机构信息
Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria.
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris Sud University, Paris, France.
出版信息
Eur J Cardiothorac Surg. 2017 Aug 1;52(2):346-355. doi: 10.1093/ejcts/ezx090.
OBJECTIVES
Surgery for thymic epithelial tumours (TETs) with pleural involvement is infrequently performed. Thus, the value of surgical therapy for primary or recurrent TETs with pleural involvement is not sufficiently defined yet.
METHODS
Twelve institutions contributed retrospective data on 152 patients undergoing surgery (1977-2014) on behalf of the ESTS Thymic Working group. Outcome measures included overall (OS), cause-specific (CSS) and disease-free (DFS) survival as well as freedom from recurrence (FFR).
RESULTS
In 70.4% of cases, pleural involvement was present at the time of primary intervention, whereas 29.6% had surgery for recurrent disease involving the pleura. Pleural involvement resulted from thymomas (88.8%) and thymic carcinomas (11.2%). Forty extrapleural pneumonectomies (EPPs), 23 total pleurectomies (TPs), and 88 local pleurectomies (LPs) were performed (completeness of resection in 76.8%). OS for the entire patient population at 1, 3, 5 and 10 years was 96.4%, 91.0%, 87.2% and 62.7%, respectively. There was no statistically significant difference regarding FFR and OS for patients with local or advanced disease undergoing EPP, TP or LP. Thymic carcinomas in comparison with thymomas had a negative impact on OS [hazard ratio 6.506, P = 0.002], CSS and FFR. Incomplete resections predicted worse OS [hazard ratio 6.696, P = 0.003].
CONCLUSIONS
Complete resection remains the mainstay of treatment for TETs with pleural involvement. Study populations treated with EPP, TP and LP had similar survival that may be factual as observed, but in the presence of selection bias, we can further conclude from the results that EPP, TP and LP are equally effective procedures. Procedural choice depends upon the extent of tumour distribution. EPPs, TPs and LPs performed within a multimodality setting seem to be efficient procedures for local control of disease, as they yield excellent results regarding OS, DFS, CSS and FFR.
目的
伴有胸膜侵犯的胸腺瘤（TET）的手术治疗很少进行。因此，对于原发性或复发性伴有胸膜侵犯的 TET 进行手术治疗的价值尚未得到充分定义。
方法
ESTS 胸腺工作组的 12 个机构代表提供了 152 例接受手术（1977-2014 年）的患者的回顾性数据。结果测量包括总生存（OS）、特异性生存（CSS）、无病生存（DFS）以及无复发生存（FFR）。
结果
在 70.4%的病例中，胸膜侵犯发生在初次干预时，而 29.6%的病例因累及胸膜的复发性疾病而行手术治疗。胸膜侵犯源于胸腺瘤（88.8%）和胸腺癌（11.2%）。40 例额外性全肺切除术（EPP）、23 例全胸膜切除术（TP）和 88 例局部胸膜切除术（LP）（76.8%的病例达到完全切除）。整个患者人群的 1、3、5 和 10 年 OS 分别为 96.4%、91.0%、87.2%和 62.7%。对于接受 EPP、TP 或 LP 的局部或晚期疾病患者，FFR 和 OS 无统计学差异。与胸腺瘤相比，胸腺癌对 OS[风险比 6.506，P=0.002]、CSS 和 FFR 有负面影响。不完全切除预示着 OS 更差[风险比 6.696，P=0.003]。
结论
完全切除仍然是伴有胸膜侵犯的 TET 的主要治疗方法。接受 EPP、TP 和 LP 治疗的研究人群的生存率相似，这可能是真实的，但在存在选择偏倚的情况下，我们还可以从结果中进一步得出结论，即 EPP、TP 和 LP 是同样有效的手术方法。手术方法的选择取决于肿瘤分布的范围。在多模式治疗环境下进行的 EPP、TP 和 LP 似乎是控制疾病局部进展的有效方法，因为它们在 OS、DFS、CSS 和 FFR 方面都取得了极好的结果。
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