Koga K, Matsuno Y, Noguchi M, Mukai K, Asamura H, Goya T, Shimosato Y
Clinical Laboratory, National Cancer Center Hospital and Research Institute, Tokyo, Japan.
Pathol Int. 1994 May;44(5):359-67. doi: 10.1111/j.1440-1827.1994.tb02936.x.
A clinicopathological study of surgically resected thymomas was performed using Masaoka's staging and modified Masaoka's staging systems, and the utility of these two staging systems was compared. The modification enabled adjustment for the disproportion in the number of cases between Stage I and Stage II. Analysis of survival rates, according to the tumor stage, indicated that the old classification should be reappraised, that is, division into non-invasive and invasive thymomas, although staging may contribute to the indication for postoperative radiotherapy, especially for Stage II disease. Analysis of the cases showed a wide spectrum of aggressiveness, varying from cases showing slow progression with a relatively favorable prognosis, such as the spindle cell type, to cases with rapid progression leading to tumor death in a relatively short time, such as the epithelial cell predominant and polygonal cell type. The pathological stage at the time of first surgical resection would reflect the degree of aggressiveness of thymoma in many instances. Therefore, not only staging the tumor extent but also grading of its aggressiveness are needed in order to predict the prognosis of patients with thymoma. For the latter, histology and cytopathology are helpful.
采用Masaoka分期系统和改良的Masaoka分期系统对手术切除的胸腺瘤进行临床病理研究，并比较这两种分期系统的实用性。改良后的分期系统能够对I期和II期病例数量不均衡的情况进行调整。根据肿瘤分期对生存率进行分析表明，尽管分期可能有助于确定术后放疗的适应证，尤其是对于II期疾病，但旧的分类（即分为非侵袭性和侵袭性胸腺瘤）应重新评估。对病例的分析显示，胸腺瘤的侵袭性范围很广，从进展缓慢、预后相对较好的类型（如梭形细胞型）到进展迅速、在相对较短时间内导致肿瘤死亡的类型（如上皮细胞为主型和多边形细胞型）。首次手术切除时的病理分期在许多情况下能够反映胸腺瘤的侵袭程度。因此，为了预测胸腺瘤患者的预后，不仅需要对肿瘤范围进行分期，还需要对其侵袭性进行分级。对于后者，组织学和细胞病理学是有帮助的。
