Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
Ann Surg Oncol. 2019 Jul;26(7):2073-2080. doi: 10.1245/s10434-019-07330-x. Epub 2019 Mar 28.
Cases of thymoma with pleural dissemination are occasionally encountered, and their management is difficult. Some reports have noted that surgical treatment for dissemination is effective, although the long-term results and clinical course details remain unclear. The current study investigated the short- and long-term outcomes of surgical resection of pleural dissemination.
A retrospective review examined the medical records for 38 patients who underwent surgical resection for pleural dissemination occurring synchronously with a primary thymoma or metachronously after complete surgical resection of a primary thymoma between 1996 and 2017 at the authors' institution. Clinical characteristics and prognostic factors were analyzed.
The patients were classified into synchronous (n = 21) and metachronous (n = 17) groups. The 10-year overall survival rate was 59% for the synchronous group and 88% for the metachronous group. The median follow-up period for all the patients was 61 months (range 4-225 months). No perioperative deaths occurred. For all the patients, the 5- and 10-year overall survival rates were respectively 91% and 82%, and the 5- and 10-year relapse-free survival rates were respectively 29% and 19%. A significantly worse prognosis was observed for patients 50 years of age or older than for those younger than 50 years (p = 0.02). For 13 patients who underwent repeat resection for pleural dissemination, the prognosis was better than for those without repeat resection (p < 0.01).
Surgical resection of thymoma with pleural disseminated nodules can be safely performed and provides a favorable long-term outcome. Repeat resection is considered to be effective for achieving a good prognosis.
胸腺瘤伴胸膜播散的病例偶有发生，其处理较为困难。有报道称，对于播散病变进行手术治疗是有效的，尽管长期结果和临床过程细节尚不清楚。本研究旨在探讨手术切除胸膜播散的短期和长期结果。
回顾性分析了 1996 年至 2017 年间作者所在机构对同步性（n=21）和异时性（n=17）原发性胸腺瘤伴胸膜播散或原发性胸腺瘤完全切除后异时性发生胸膜播散的 38 例患者的病历资料。分析了临床特征和预后因素。
患者分为同步性（n=21）和异时性（n=17）组。同步组的 10 年总生存率为 59%，异时组为 88%。所有患者的中位随访时间为 61 个月（范围 4-225 个月）。无围手术期死亡。所有患者的 5 年和 10 年总生存率分别为 91%和 82%，5 年和 10 年无复发生存率分别为 29%和 19%。50 岁及以上患者的预后明显差于 50 岁以下患者（p=0.02）。对于 13 例接受胸膜播散结节重复切除术的患者，预后优于未接受重复切除术的患者（p<0.01）。
胸腺瘤伴胸膜播散结节的手术切除是安全的，可获得良好的长期结果。重复切除被认为是获得良好预后的有效方法。
