摘要
目的 探讨胸腺瘤术后临床病理分期、术后放疗与患者预后的相关性.方法 收集中国胸腺肿瘤研究协作组回顾性数据库中1998年3月15日至2013年10月1月有完整随访记录的917例胸腺瘤患者资料.男464例,女453例;年龄15～83岁,平均（51 ±11）岁;病程1个月至5年.MasaokaKoga分期Ⅰ期患者436例（占47.5％）,Ⅱ期205例（占22.4％）,Ⅲ期221例（占24.1％）,Ⅳ期55例（占6.0％）.术后随访3个月至10年,平均（62.3±18.5）个月.统计分析各期患者手术疗效、病变病理分期、生存率等数据资料.结果 全组患者术后5年生存率为90.5％,10年85.1％,15年83.2％.Ⅲ、Ⅳ期患者生存率比Ⅰ、Ⅱ期明显下降（x2=23.26,P＜0.001）.Kaplan-Meier生存分析结果显示,远期预后与Masaoka-Koga分期相关（x2=36.085,P＜0.001）.行R0切除的Ⅰ、Ⅱ、Ⅲ期患者,远期预后与术后是否放疗无明显相关性（x2 =0.383,P=0.536;x2=1.923,P=0.166;x2=0.426,P=0.514）.行R1＋R2切除的Ⅲ期患者,术后是否放疗对远期预后无显著影响（x2=1.288,P=0.256）.结论 外科手术治疗胸腺瘤安全有效,术后生存率与Masaoka-Koka分期密切相关,Ⅲ、Ⅳ期与Ⅰ、Ⅱ期患者相比总体生存率明显降低,复发率明显提高.R0切除的Ⅰ、Ⅱ期胸腺瘤患者术后放疗对远期生存率无明显意义.对于不完整切除的胸腺瘤患者推荐术后挽救放疗.
Objective To analyze and discuss the relationship between the pathological staging of thymoma postoperative and prognosis.Methods Patients with thymoma acceptance of different surgical methods for treating 917 cases （with 464 males and 453 females） of surgical treatment of clinical data,disease staging,survival rates were analyzed.The mean age was （51 ＋ 11）years,ranged 15-83 years old.Masaoka-Koga stage Ⅰ patients were 436 cases（47.5％）,stage Ⅱ were 205 cases （22.4％）,stage Ⅲ were 221 cases （24.1％）,stage Ⅳ were 55 cases （6.0％）.Postoperative follow-up was （62.3 ± 18.5） months.Results The overall 5-year survival rate after surgery was 90.5 ％,10-year survival rate was 85.1％,15-year survival rate was 83.2％.Stage Ⅲ,Ⅳ of survival decreased significantly（x2 =23.26,P ＜0.001）.Kaplan-Meier survival analysis showed that the long-term prognosis is correlated with Masaoka-Koga staging（x2 =36.085,P ＜0.001）.In addition,we confirmed that stage Ⅰ and Ⅱ patients with R0 resection,long-term prognosis had no correlationship with whether postoperative radiotherapy or not（x2 =0.383,P =0.536;x2 =1.923,P =0.166）.Stage Ⅲ patients with R0 or R1 ＋ R2 resection,whether postoperative radiotherapy had no effect on long-term prognosis （x2 =0.426,P =0.514;x2 =1.288,P =0.256）.Conclusion Surgical treatment of thymoma is safe and effective,postoperative survival is closely related to disease staging.Stage Ⅲ and Ⅳ lesions was significantly lower in patients with long-term survival prognosis,recurrence rate was significantly improved.R0 resection of stage Ⅰ and Ⅱ patients after radiotherapy on survival rate has no obvious significance.
出处
《中华胸心血管外科杂志》
CSCD
2017年第5期286-289,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
胸腺肿瘤
外科手术
病理分期
放射疗法
预后
Thymus neoplasms
Surgical procedures
Pathological stage
Radiotherapy
Prognosis
