摘要
目的探讨分析胸腺瘤切除术后患者预后及临床危险因素。方法回顾性分析2005年1月至2015年12月期间在北京同仁医院(首都医科大学重症肌无力&胸腺瘤诊疗中心)行胸腺瘤切除术的154例患者病例资料。其中男74例,女80例;中位年龄52(22~77)岁。合并重症肌无力121例(78.6%)。胸腺瘤病理分型A、AB、B、B1、B2和B3型分别为5、35、27、56和31例。Masaoka-koga分型Ⅰ~Ⅳ期分别为80、16、45和13例。胸腔镜辅助下手术治疗122例,经胸骨正中治疗32例。采用Kaplan-Meier法统计无进展生存期,Log-rank法行差异性检验。对性别、年龄、是否合并重症肌无力、手术切除完整程度、WHO病理分型、Masaoka-Koga分期行Cox回归分析,探讨影响预后的相关危险因素。结果154例患者1、5、10年无进展生存比例分别为98.7%、88.3%和78.7%。单因素分析结果显示,年龄、手术切除完整程度、WHO病理分型和Masaoka-Koga分期是影响预后的危险因素。多因素分析结果显示,年龄、WHO病理分型和Masaoka-Koga分期是影响预后的独立危险因素。结论胸腺瘤应早发现、早治疗。可行手术治疗的胸腺瘤患者应尽可能完全切除瘤体,并切除胸腺及胸腺区脂肪。不能完全切除的胸腺瘤,术后应行辅助放疗以降低肿瘤复发风险。胸腺瘤术后治疗重症肌无力对预后尤为关键。
Objective To explore the prognosis and clinical risk factor of thymoma patients after resection.Methods A retrospectively analysis of 154 cases of thymoma patients underwent thymoma resection in Beijing Tongren Hospital(Myasthenia Gravis&Thymoma Diagnosis and Treatment Center,Capital Medical University)from January 2005 to December 2015,and then the progress-free survival was calculated by Kaplan-Meier method,the differences between curves were analyzed by log-rank test.There were 74 males and 80 females;the median age was 52(22-77)years.121 cases(78.6%)complicated with myashenia gravis.Thymoma cases were classfied into 5 cases A,35 cases AB,27 cases B1,56 cases B2 and 31 cases B3 respectively.There were 80,16,45 and 13 patients with Masaoka-Koga typeⅠ-Ⅳ,respectively.122 cases were treated by thoracoscopic assisted operation,32 cases were treated by median sternum.The risk factors about group of gender,age,thymoma-associated MG(Myasthenia Gravis),completeness of resection,histologic type and Masaoka-Koga stage were calculated by Cox regression analysis.Results The overall 1-,5-10-year progress-free survival rate of 154 cases were 98.7%,88.3%,and 78.7%,respectively.The adverse prognostic factors for progress-free survival were age,completeness of resection,WHO histologic classification and Masaoka-Koga stage at univariate analysis.The age,WHO histologic classification and Masaoka-Koga stage were the independent risk factors at multivariate analysis.Conclusion For thymoma,we suggest early discovery and early treatment.For the thymoma patients who are available for surgical treatment,all the tumor,thymus and surrounding adipose tissue should be resected.For the thymoma patients whose tumors cannot excise completely,adjuvant radiotherapy can reduce the risk for tumor recurrence after resection.For patients with thymoma after surgery,MG treatment is particularly critical for prognosis.
作者
杜鑫
于磊
李飞
张葆勋
余振
杨兴国
姜宇轩
于鑫韬
Du Xin;Yu Lei;Li Fei;Zhang Baoxun;Yu Zhen;Yang Xingguo;Jiang Yuxuan;Yu Xintao(Department of Thoracic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2021年第10期615-617,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
北京市医院管理局临床技术创新项目(XMLX201839)。
