Park H S, Shin D M, Lee J S, Komaki R, Pollack A, Putnam J B, Cox J D, Hong W K
Department of Thoracic/Head and Neck Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Cancer. 1994 May 15;73(10):2491-8. doi: 10.1002/1097-0142(19940515)73:10<2491::aid-cncr2820731007>3.0.co;2-6.
The authors retrospectively analyzed 87 patients with malignant thymoma treated at M.D. Anderson Cancer Center between 1951 and 1990. The analysis examined the clinical stages, histologic types, and treatment modalities and attempted to determine if chemotherapy had an impact on survival.
The patients were divided into three groups by their year of treatment and treatment modality. Patients treated between 1951 and 1975 were in Group I; patients treated between 1976 and 1980 were in Group II; and patients treated between 1981 and 1990 were in Group III. Most of the patients (18 [72%] in Group I; 16 [62%] in Group II; and 18 [50%] in Group III) had surgical resection alone or with radiotherapy. Patients with advanced-stage disease in Group I received single-agent chemotherapy, whereas patients with advanced-stage disease in Group II received a different, combination chemotherapy regimen, and those in Group III were treated primarily with cisplatin- and doxorubicin-based combination chemotherapy, e.g., the cyclophosphamide doxorubicin, and cisplatin with or without prednisone. The 17 patients treated with cisplatin with or without prednisone were separately evaluated for survival according to their response.
Twenty-eight patients (5 [20%] in Group I; 6 [23%] in Group II; and 17 [47%] in Group III) received chemotherapy alone or after surgery or radiotherapy. The cisplatin with or without prednisone regimen was used in 17 Group III patients for initial treatment or for relapse. The overall response rate among the patients receiving the cisplatin with or without prednisone regimen was 64%; 6 (35%) had a complete response, and 5 (29%) had a partial response. Thirty-one (36%) of the 87 total patients had 45 recurrent tumors; the lung (29%), pleura (22%), and mediastinum (18%) were the most common sites of recurrence, whereas bone was the most common distant metastatic site. The 5-year survival rate was 70% in patients with Stage I disease, 71% in patients with Stage II or III disease, and 46% in patients with Stage IV disease. The 10-year survival rate was 70% in patients with Stage I disease, 47% in patients with Stage II or III disease, and 21% in patients with Stage IV disease. Statistical analysis indicated a significant difference among the survival rates of patients with noninvasive Stage I, invasive Stage II plus III (P = 0.033), and Stage II plus III and IV tumors (P = 0.056), but not between patients with Stage II or III tumors. Patients with a major response to the cisplatin with or without prednisone regimen had a significant survival improvement compared to those with no response (P = 0.002, log-rank test).
Because thymoma is a chemosensitive tumor and frequently recurs in patients with Stage II or greater disease, chemotherapy carries a potential survival benefit and should be incorporated into the multimodality approach to prolong disease-free survival.
作者回顾性分析了1951年至1990年间在MD安德森癌症中心接受治疗的87例恶性胸腺瘤患者。该分析考察了临床分期、组织学类型和治疗方式，并试图确定化疗是否对生存有影响。
根据治疗年份和治疗方式将患者分为三组。1951年至1975年接受治疗的患者为第一组；1976年至1980年接受治疗的患者为第二组；1981年至1990年接受治疗的患者为第三组。大多数患者（第一组18例[72%]；第二组16例[62%]；第三组18例[50%]）仅接受手术切除或手术联合放疗。第一组晚期疾病患者接受单药化疗，而第二组晚期疾病患者接受不同的联合化疗方案，第三组患者主要接受以顺铂和阿霉素为基础的联合化疗，如环磷酰胺、阿霉素和顺铂，加或不加泼尼松。对17例接受顺铂加或不加泼尼松治疗的患者，根据其反应分别评估生存情况。
28例患者（第一组5例[20%]；第二组6例[23%]；第三组17例[47%]）单独接受化疗或在手术或放疗后接受化疗。17例第三组患者使用顺铂加或不加泼尼松方案进行初始治疗或复发治疗。接受顺铂加或不加泼尼松方案治疗的患者总体缓解率为64%；6例（35%）完全缓解，5例（29%）部分缓解。87例患者中有31例（36%）出现45次复发肿瘤；肺（29%）、胸膜（22%）和纵隔（18%）是最常见的复发部位，而骨是最常见的远处转移部位。I期疾病患者的5年生存率为70%，II期或III期疾病患者为71%，IV期疾病患者为46%。I期疾病患者的10年生存率为70%，II期或III期疾病患者为47%，IV期疾病患者为21%。统计分析表明，非侵袭性I期、侵袭性II期加III期（P = 0.033）以及II期加III期和IV期肿瘤患者的生存率之间存在显著差异，但II期或III期肿瘤患者之间无显著差异。与无反应者相比，对顺铂加或不加泼尼松方案有主要反应的患者生存有显著改善（P = 0.002，对数秩检验）。
由于胸腺瘤是一种对化疗敏感的肿瘤，且在II期或更晚期疾病患者中经常复发，化疗具有潜在的生存益处，应纳入多模式治疗方法以延长无病生存期。
