胸腺瘤：预后因素与治疗结果

Thymoma: prognostic factors and treatment outcomes.

作者信息

Gripp S, Hilgers K, Wurm R, Schmitt G

机构信息

Department of Radiation Oncology, Heinrich-Heine-University Düsseldorf, Germany.

出版信息

Cancer. 1998 Oct 15;83(8):1495-503.

PMID:9781943

Abstract

BACKGROUND

The objective of this study was to establish prognostic factors for thymoma and determine the impact of surgery with or without postoperative radiotherapy.

METHODS

Seventy patients treated at the University Hospital Düsseldorf during the period 1954-1991 were retrospectively studied. All thymoma patients underwent surgery, 22 received postoperative radiotherapy, and 3 also received chemotherapy. According to thymoma staging as described previously by Masaoka et al., 21% were Stage I, 26% Stage II, 43% Stage III, 7% Stage IVA, and 3% Stage IVB. Lymphocytic type disease was found in 36% of patients, lymphoepithelial type in 33%, epithelial type in 23%, and spindle cell type in 9%. The relevance of Karnofsky performance status (KPS), gender, age, myasthenia gravis, histology, tumor size, and stage to survival was determined by univariate analysis, and their independent significance was tested by multivariate analysis. Survival rates were calculated using the Kaplan-Meier method and the log rank test.

RESULTS

In univariate analysis, KPS (P < 0.001), histologic type (P=0.0093), and stage (P=0.0001) proved to be significant predictors of overall survival. Spindle cell type was associated with the best and epithelial type the worst prognosis; patients with the latter type had a 5-year survival rate of 30%. Multivariate analysis revealed that stage, histology, and KPS were predictive of overall survival. In Stages III and IV, relapses were reduced by postoperative radiotherapy from 50% to 20%. The site of relapse was outside the irradiated area in 80% of patients. Disease free survival (P=0.36) and median survival (P=0.72) of patients with completely resected advanced thymomas did not differ from that for patients with incompletely resected tumors who received radiotherapy.

CONCLUSIONS

Postoperative radiotherapy can improve local control in patients with advanced thymoma. Survival after incomplete resection is not compromised when postoperative radiotherapy is employed. KPS should be considered an important prognostic factor in future studies.

摘要

背景

本研究的目的是确定胸腺瘤的预后因素，并确定手术联合或不联合术后放疗的影响。

方法

对1954年至1991年期间在杜塞尔多夫大学医院接受治疗的70例患者进行回顾性研究。所有胸腺瘤患者均接受了手术，22例接受了术后放疗，3例还接受了化疗。根据Masaoka等人先前描述的胸腺瘤分期，21%为I期，26%为II期，43%为III期，7%为IVA期，3%为IVB期。36%的患者为淋巴细胞型疾病，33%为淋巴上皮型，23%为上皮型，9%为梭形细胞型。通过单因素分析确定卡诺夫斯基功能状态（KPS）、性别、年龄、重症肌无力、组织学、肿瘤大小和分期与生存的相关性，并通过多因素分析检验其独立意义。使用Kaplan-Meier方法和对数秩检验计算生存率。

结果

在单因素分析中，KPS（P < 0.001）、组织学类型（P = 0.0093）和分期（P = 0.0001）被证明是总生存的重要预测因素。梭形细胞型预后最佳，上皮型最差；后者类型的患者5年生存率为30%。多因素分析显示，分期、组织学和KPS可预测总生存。在III期和IV期，术后放疗使复发率从50%降至20%。80%的患者复发部位在放疗区域之外。完全切除的晚期胸腺瘤患者的无病生存期（P = 0.36）和中位生存期（P = 0.72）与接受放疗的不完全切除肿瘤患者的无病生存期和中位生存期无差异。