胸腺瘤105例临床分析

THYMOMAS—Analysis of 105 cases

胸腺瘤术中肉眼所见的浸润性是影响预后的重要因素。但是组织学病理类型对预后的意义还有争论,为了解各病理类型对预后的影响及其临床特性、转归,以便进一步明确治疗原则,本文复习有明确组织学病理分类的胸腺瘤105例,并作分析和讨论。

From March 1958 to December 1987, 105 patients with pathologically proven thymoma were treated. Thirty-nine patients had epithelial cell type, 44 lymphocytic predominant type and 22 mixed type. Among the invasive thyrno-mas, there were 28 (76%-28/37) epithelial cell type, 19 (45%-19/42) lymphocytic type and 10(46%-10/22) mixed type, (P<0 .025).The overal 5-year survival rate was 69% and 10-year survival rate was 62%. The presence of invasion was the most important prognostic factor. The 5-, 10- year survival rates of invasive and non-invasive thymomas were 55%, 38%, and 88%, 85%, respectively. (P<0.01) The other prognostic factors werej the presence of myasthenia gravis, invasion of pericardium and the thoroughness of surgical resection. It was also found that the epithelial cell type thymomas were more invasive, having more extra-or intra-thoracic metastasis, It carried a worse prognosis. The histologic subtypes were not relevant. The authors do not support the administration of post-operative irradiation for non-invasive thymomas after radical resection, Aggressive surgical resection supplemented by post-operative radiotherapy is recommended for invasive lesions. The authors believe that the radiation field should include the local tumor bed, but prophylactic treatment to the bilateral supraclavicular areas is not necessary.