Blumberg D, Port J L, Weksler B, Delgado R, Rosai J, Bains M S, Ginsberg R J, Martini N, McCormack P M, Rusch V
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Thorac Surg. 1995 Oct;60(4):908-13; discussion 914. doi: 10.1016/0003-4975(95)00669-c.
Despite complete surgical excision, malignant thymomas often recur with resultant death. We reviewed our series to determine which factors independently predict survival after surgical resection.
A retrospective analysis of patients operated on for thymoma between 1949 and 1993 at Memorial Sloan-Kettering Cancer Center was performed. Clinical data were collected from chart review. Only patients with a pathology report confirming the diagnosis of thymoma were included in this analysis. Kaplan-Meier survival curves were generated and comparisons of survival analyzed by log rank test. Multivariate analysis was performed by the Cox proportional hazard model.
One hundred eighteen patients with thymoma underwent operation. There were 86 complete resections (73%), 18 partial resections (15%), and 14 biopsies (12%). By Masaoka staging, 25 patients were stage I (21%), 41 stage II (35%), 43 stage III (36%), and 9 stage IVa (8%). Overall survival was 77% at 5 years and 55% at 10 years. Tumor recurred in 25 (29%) of 86 completely resected thymomas. Stage of disease (p = 0.03) was the only independent prognostic factor affecting recurrence. By multivariate analysis, stage (p = 0.003), tumor size (p = 0.0001), histology (p = 0.004), and extent of surgical resection (p = 0.0006) were independent predictors of long-term survival.
Patients with stage I disease require no further therapy after complete surgical resection. Neoadjuvant therapy should be considered for patients with large tumors and invasive disease.
尽管进行了完整的手术切除，恶性胸腺瘤仍常复发并导致死亡。我们回顾了我们的病例系列，以确定哪些因素能独立预测手术切除后的生存率。
对1949年至1993年在纪念斯隆凯特琳癌症中心接受胸腺瘤手术的患者进行了回顾性分析。临床数据通过病历审查收集。本分析仅纳入了病理报告确诊为胸腺瘤的患者。生成了Kaplan-Meier生存曲线，并通过对数秩检验分析生存率的比较。采用Cox比例风险模型进行多变量分析。
118例胸腺瘤患者接受了手术。其中86例完整切除（73%），18例部分切除（15%），14例活检（12%）。根据Masaoka分期，25例为I期（21%），41例为II期（35%），43例为III期（36%），9例为IVa期（8%）。5年总生存率为77%，10年为55%。86例完全切除的胸腺瘤中有25例（29%）复发。疾病分期（p = 0.03）是影响复发的唯一独立预后因素。多变量分析显示，分期（p = 0.003）、肿瘤大小（p = 0.0001）、组织学（p = 0.004）和手术切除范围（p = 0.0006）是长期生存的独立预测因素。
I期疾病患者在完整手术切除后无需进一步治疗。对于肿瘤较大和有侵袭性疾病的患者，应考虑新辅助治疗。
