Okada Y, Kondo T, Handa M, Saito R, Oura H, Shimada K, Hirose M, Horikoshi A, Fujimura S
Department of Surgery, Tohoku University, Sendai, Japan.
Kyobu Geka. 1993 Jan;46(1):35-40.
The relationship between prognosis of the disease and the type of surgery were reviewed in 110 cases of thymoma. Surgical procedures were classified into four types: total resection (TR), subtotal resection (SR), partial resection (PR) and exploratory thoracotomy (ET), and the extent of the disease was expressed as stage I through IV based on Masaoka's classification. Ten-year survival rates for stage III and IVa diseases were 5 6.2% in TR, 37.9% in SR and 30.3% in PR. None of the patients in ET survived more than 28 months. Tumor death after surgery was not observed in TR. Two of three patients with stage IVa disease who underwent TR are alive without recurrence of the tumor at 37 months and 6 months after surgery. The pleuropneumonectomy was performed in the former case. One of four patients who underwent SR and one of three patients who underwent PR both with stage IVa disease are alive at 71 and 150 months after surgical intervention, respectively, in spite of the presence of the tumor relapse. In these patients, repeated chemotherapy and radiotherapy were administered following the resection of the primary lesion. In conclusion, it was indicated that the improvement of the survival rate could be obtained by resection the tumor as completely as possible in stage III and IVa thymoma, as long-term survival has been proved to be possible by macroscopically complete removal of the primary site and pleural disseminations followed by combined adjuvant therapy in patient with stage IVa disease.
回顾了110例胸腺瘤患者疾病预后与手术类型之间的关系。手术方式分为四种类型：全切除（TR）、次全切除（SR）、部分切除（PR）和剖胸探查术（ET），疾病范围根据Masaoka分类法分为I至IV期。III期和IVa期疾病的10年生存率在TR组为56.2%，SR组为37.9%，PR组为30.3%。ET组患者无一存活超过28个月。TR组术后未观察到肿瘤死亡。接受TR的3例IVa期疾病患者中有2例在术后37个月和6个月时存活，肿瘤无复发。前一例患者进行了胸膜肺切除术。4例接受SR的患者中有1例以及3例接受PR的患者中有1例均为IVa期疾病，尽管存在肿瘤复发，但分别在手术干预后71个月和150个月时仍存活。在这些患者中，在切除原发灶后进行了反复的化疗和放疗。总之，结果表明，在III期和IVa期胸腺瘤中，尽可能彻底地切除肿瘤可提高生存率，因为对于IVa期疾病患者，通过宏观上完全切除原发部位和胸膜播散灶并联合辅助治疗已证明可以实现长期生存。
