胸腺瘤TNM分期系统的影响。
Impact of the TNM staging system for thymoma.
作者信息
Smith Alex, Cavalli Camilla, Harling Leanne, Harrison-Phipps Karen, Routledge Tom, Pilling John, King Juliet, Bille Andrea, Nonaka Daisuke
机构信息
Department of Thoracic Surgery, Guy's Hospital, Great Maze Pond, London, UK.
King's College London, The Strand, London, UK.
出版信息
Mediastinum. 2021 Dec 25;5:32. doi: 10.21037/med-21-24. eCollection 2021.
BACKGROUND
Masaoka-Koga staging system remains the most frequently applied clinical staging system for thymic malignancy. However, the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancy Interest Group (ITMIG) proposed a tumor-node-metastasis (TNM) staging system in 2014. This study aims to evaluate its impact on stage distribution, clinical implementation, and prognosis for thymomas.
METHODS
We performed a single institution, retrospective analysis of 245 consecutive patients who underwent surgical resection for thymoma. 9 patients with thymic carcinoma were excluded. No patients were lost to follow up. Kaplan-Meier survival analysis was used to calculate overall survival.
RESULTS
Median age was 62 years; 129 patients (53%) were female. The median overall survival was 158 months (range, 108-208 months), and disease-free survival 194 months (range, 170-218 months). At the end of follow up 63 patients were dead. Early Masaoka-Koga stages I (n=74) and II (n=129) shifted to the IASLC/ITMIG stage I (n=203). 8 patients were down staged from Masaoka-Koga stage III to IASLC/ITMIG stage II because of pericardial involvement. Advanced stages III (Masaoka-Koga: n=30; IASLC/ITMIG: n=22) and IV (Masaoka-Koga: n=12; IASLC/ITMIG: n=12) remained similar and were associated with more aggressive WHO thymoma histotypes (B2/B3). Masaoka-Koga (P=0.004), IASLC/ITMIG staging (P<0.0001) and complete surgical resection (P<0.0001) were statistically associated with survival. At multivariate analysis only R status was an independent prognostic factor for survival.
CONCLUSIONS
The proportion of patients with stage I disease increased significantly when IASLC/ITMIG system used, whilst the proportion with stages III and IV were similar in both systems. Completeness of resection, Masaoka-Koga and the IASLC/ITMIG staging system are strong predictors of survival. The TNM staging system is useful in disease management and a strong predictor of overall survival.
背景
Masaoka-Koga分期系统仍是最常用于胸腺恶性肿瘤的临床分期系统。然而，国际肺癌研究协会（IASLC）/国际胸腺恶性肿瘤研究兴趣小组（ITMIG）在2014年提出了一种肿瘤-淋巴结-转移（TNM）分期系统。本研究旨在评估其对胸腺瘤分期分布、临床应用及预后的影响。
方法
我们对245例连续接受胸腺肿瘤手术切除的患者进行了单中心回顾性分析。排除9例胸腺癌患者。无患者失访。采用Kaplan-Meier生存分析计算总生存期。
结果
中位年龄为62岁；129例患者（53%）为女性。中位总生存期为158个月（范围108 - 208个月），无病生存期为194个月（范围170 - 218个月）。随访结束时，63例患者死亡。早期Masaoka-Koga分期I期（n = 74）和II期（n = 129）转变为IASLC/ITMIG分期I期（n = 203）。8例患者因心包受累从Masaoka-Koga分期III期降为IASLC/ITMIG分期II期。晚期III期（Masaoka-Koga：n = 30；IASLC/ITMIG：n = 22）和IV期（Masaoka-Koga：n = 12；IASLC/ITMIG：n = 12）保持相似，且与更具侵袭性的世界卫生组织胸腺瘤组织学类型（B2/B3）相关。Masaoka-Koga分期（P = 0.004）、IASLC/ITMIG分期（P < 0.0001）及完整手术切除（P < 0.0001）与生存具有统计学相关性。多因素分析时，仅R状态是生存的独立预后因素。
结论
采用IASLC/ITMIG系统时，I期疾病患者比例显著增加，而III期和IV期患者比例在两个系统中相似。切除完整性、Masaoka-Koga分期及IASLC/ITMIG分期系统是生存的有力预测因素。TNM分期系统在疾病管理中有用，且是总生存的有力预测因素。
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