胸腺瘤的诊断和预后影响因素分析

Influence factors on diagnosis and prognosis of thymoma: analysis of 135 cases

目的 探讨影响胸腺瘤的诊断与预后的相关因素。方法 回顾性分析 135例胸腺瘤患者的临床资料 ,logistic回归分析影响肿瘤复发的相关因素。 结果 胸腺瘤的临床表现多样 ,最常见的是重症肌无力 (6 6 / 135 ,4 8 9% )。出现上腔静脉压迫症状提示肿瘤为恶性 (χ2 =8 373,P =0 0 0 4 )。病程长、男性患者患恶性胸腺瘤的可能性较大 (U =16 91 5 ,P =0 0 13;χ2 =6 12 5 ,P =0 0 13)。胸腺瘤是否钙化及坏死与肿瘤的良恶性无关 (χ2 =0 12 1,P =0 72 8;χ2 =0 4 87,P =0 4 85 )。肿瘤的复发与患者的病程和Masaoka分期呈正相关 [Exp(b) =1 0 5 0、6 72 8,P =0 0 38、0 0 0 3],年龄小、女性患者复发机会小。胸腺瘤复发率Ⅰ期为 2 7% ,Ⅱ期为 11 1% ,Ⅲ期为 30 4 % ,Ⅳ期为 83 3%。结论 胸腺瘤是一种起病隐匿、表现多样的疾病 ,其影像学表现对良恶性的判断欠准确 ,Masaoka分期能提示患者的预后 ;

Objective To investigate the clinical features and prognostic factors of thymoma. Methods 135 patients with a diagnosis of thymoma or thymic carcinoma were identified in Peking Union Medical University Hospital from Jan,1990 to Feb,2003. Their clinical presentation and prognostic factors were analyzed. Results Of the 135 patients, 21 (15.6%) were asymptomatic and 66 (48.9%) presented symptoms consistent with myasthenia gravis. Venous obstruction, male gender and longer disease course appeared to be the predisposing factors of malignancy (χ~2=8.373, P=0.004; χ~2=6.125, P=0.013; (U=)1691.5, P=0.013 respectively). Calcification and necrosis on radiological findings did not differentiate thymoma from thymic carcinoma. Tumor recurrence was related to the Masaoka stage and the course of disease by logistic method [Exp(b)= 1.050?6.728,P=0.038?0.003]. The recurrence rate was 2.7% in stageⅠ, 11.1% in stage Ⅱ, 30.4% in stage Ⅲ, and 83.3% in stage Ⅳ. Conclusions Thymoma has a variable clinical manifestation. Clinical outcome is correlated with Masaoka stage and early tumor resection. Radiographic findings are not reliable in the differentiation of benign tumor from malignancy.