摘要
目的探讨原发性纵隔恶性生殖细胞瘤(primary mediastinal malignant germ cell tumor,PMMGCT)的临床特点、诊断要点、治疗方法及预后影响因素。方法报道PMMGCT 1例,并检索万方、知网数据库1982~2019年的文献资料,收集有随访资料的病例,分析与预后有关的因素,单因素分析采用Kaplan-Meier模型的Log-rank检验,多因素分析采用Cox比例风险模型。结果共155例患者入组,其中46例(29.7%)为原发性纵隔精原细胞瘤(primary mediastinal seminomas,PMSGCT),109例(70.3%)为原发性纵隔非精原细胞瘤(primary mediastinal non-seminomas,PMNSGCT),PMMGCT的1年、3年、5年生存率分别为57.4%、43.5%、25.7%,中位生存期为21个月。单因素分析显示性别、年龄及手术与否对患者的预后无影响,而病理类型、临床分期、肿瘤长径、胸外转移、化疗与否及放疗与否6项因素可影响PMMGCT的预后(P<0.05),多因素分析显示病理类型、胸外转移、化疗与否及放疗与否是患者预后的独立影响因素(P<0.05)。结论PMMGCT多发于20~40岁男性患者,临床症状不典型,目前治疗上采用放化疗综合治疗,PMNSGCT预后明显差于PMSGCT,胸外转移者预后差,早期正确诊断及规范治疗对PMMGCT至关重要。
Objective To investigate the clinical characteristics,diagnosis,treatment and prognostic factors of primary mediastinal malignant germ cell tumors(PMMGCT).Methods 1 case of PMMGCT was reported.WanFang and CNKI databases were retrieved from 1982 to 2019.Domestic cases with follow-up data were collected and prognostic factors were analyzed.Log-rank test of Kaplan-Meier model was used for univariate analysis,and Cox proportional risk model was used for multiple-factor analysis.Results A total of 155 patients were enrolled,among which 46 cases(29.7%)were primary mediastinal seminomas(PMSGCT)and 109 cases(70.3%)were primary mediastinal non-seminomas(PMNSGCT).The 1-year,3-year and 5-year survival rates of PMMGCT were 57.4%,43.5%and 25.7%,respectively,and the median survival was 21 months.Univariate analysis showed that gender,age and operation had no effect on the prognosis of patients,while six factors,including pathological type,clinical stage,tumor length,external thoracic metastasis,chemotherapy and radiotherapy,had effect on the prognosis of PMMGCT(P<0.05).Multivariate analysis showed that pathological type,external thoracic metastasis,chemotherapy and radiotherapy were independent factors influencing the prognosis of patients(P<0.05).Conclusion PMMGCT mainly occurs in male patients aged 20~40 years old,with atypical clinical symptoms.Currently,comprehensive radiotherapy and chemotherapy are used in the treatment.The prognosis of PMNSGCT is significantly worse than that of PMSGCT,and the prognosis of patients with external thoracic metastasis is poor.Early correct diagnosis and standard treatment are especially important for PMMGCT.
作者
王梦
崔新征
赵卫浩
张清勇
Wang Meng;Cui Xinzheng;Zhao Weihao(The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003)
出处
《中国现代医药杂志》
2019年第11期29-33,共5页
Modern Medicine Journal of China
