Nakahara K, Ohno K, Hashimoto J, Maeda H, Miyoshi S, Sakurai M, Monden Y, Kawashima Y
First Department of Surgery, Osaka University Medical School, Japan.
J Thorac Cardiovasc Surg. 1988 Jun;95(6):1041-7.
A series of 141 patients with thymoma was studied with regard to the way in which complete resection followed by postoperative radiation therapy influenced prognosis according to the stage and histologic type of thymoma. Postoperative radiation therapy (30 Gy in 3 weeks to 50 Gy in 6 weeks) was performed in 73.1% of the patients. Thirty-five of 48 patients with thymoma invading the surrounding tissues (stage III) underwent complete resection, with survival rates of 100% at 5 years and 94.7% at 10 and 15 years. The prognosis in these patients was comparable with those in 45 patients with no invasion (stage I) and in 33 patients with capsular invasion (stage III), all of whom underwent complete resection. Complete resection was done in 18 of 26 patients with epithelial cell thymoma, and there were no deaths by tumor until 15 years after the operation. There were no statistically significant differences in the survival rates of patients undergoing complete resection according to cell type (33 of 36 patients with lymphocyte predominant type and 61 of 77 patients with mixed cell type). The survival rate in six patients with epithelial cell type who underwent subtotal resection was not significantly different from that of 12 patients who underwent biopsy alone. Our findings indicate that complete resection of thymoma followed by postoperative radiation therapy results in a "benign" postoperative course, regardless of the stage and histologic type. Therefore, an aggressive surgical approach, such as resection of the superior vena caval system followed by reconstruction with a ringed polytetrafluoroethylene graft and/or complete pleuropneumonectomy, is justified for advanced thymoma, although the long-term results of such extended operations are still unclear.
对141例胸腺瘤患者进行了研究，探讨根据胸腺瘤的分期和组织学类型，完整切除后进行术后放疗对预后的影响。73.1%的患者接受了术后放疗（3周内30 Gy至6周内50 Gy）。48例侵犯周围组织的胸腺瘤患者（III期）中有35例接受了完整切除，5年生存率为100%，10年和15年生存率为94.7%。这些患者的预后与45例无侵犯患者（I期）和33例有包膜侵犯患者（II期）相当，所有这些患者均接受了完整切除。26例上皮细胞型胸腺瘤患者中有18例进行了完整切除，术后15年内无肿瘤死亡病例。根据细胞类型，接受完整切除的患者生存率无统计学显著差异（淋巴细胞为主型36例中的33例和混合细胞型77例中的61例）。6例接受次全切除的上皮细胞型患者的生存率与12例仅接受活检的患者的生存率无显著差异。我们的研究结果表明，胸腺瘤完整切除后进行术后放疗会导致“良性”的术后病程，无论分期和组织学类型如何。因此，对于晚期胸腺瘤，积极的手术方法，如切除上腔静脉系统后用带环聚四氟乙烯移植物重建和/或全胸膜肺切除术是合理的，尽管这种扩大手术的长期结果仍不清楚。
