259例胸腺瘤术后放疗长期生存结果及预后因素分析

The long-term outcome of postoperative radiotherapy and prognostic factors in 259 thymoma patients

目的回顾性分析259例胸腺瘤治疗结果,试图获得影响胸腺瘤术后放疗长期生存的预后因素.方法 267例中符合入组条件的胸腺瘤共259例进入研究,其中男166例,女93例 ,中位年龄45岁.Masaoka分期Ⅰ期55例,Ⅱ期56例,Ⅲ期131例,Ⅳ期17例.手术完全切除 179例,不完全切除62例,仅做活检18例.259例术后常规放疗的中位剂量为4939 cGy(2148 ～6691 cGy).72例在不同时期接受了环磷酰胺、阿霉素、顺铂,氟尿嘧啶、长春新碱等的化疗.用Kaplan-Meier法计算总生存率、肿瘤特异性生存率、无瘤生存率和局部控制率.C ox回归比例风险模型用于影响预后的多因素分析.结果全组5、10年总生存率分别为81%、69% .5、10年肿瘤特异性生存率分别为82%、72%.5、10年无瘤生存率分别为74%、60%.5、10 年局部控制率分别为82%、73%.Ⅰ、Ⅱ、Ⅲ、Ⅳ期的5年总生存率分别为94%、85%、74%、36 %,10年总生存率分别为85%、61%、49%和24%.多因素分析显示Masaoka分期、手术切除的完全性、肿瘤包膜有无侵犯和性别是影响长期生存的独立预后因素.结论全组5、10年总生存率较高,Masaoka分期、手术切除的完全性、肿瘤包膜有无侵犯是影响胸腺瘤手术后放疗预后的主要因素.

Objective To analyze the prognostic factors of 259 patients with pathologically confirmed thymoma treated by postoperative radiotherapy in Cancer Hospital, Fudan University. Methods According to Masaoka staging criteria, there were 55 stage Ⅰ, 56 stage Ⅱ , 131 stage Ⅲ and 17 stage Ⅳ lesions. Among them, 179 patients underwent gross total resection, 62 subtotal resection, and 18 biopsy alone. Irradiation dose ranged from 2148 cGy to 6691 cGy, with a median of 4939 cGy. Overall survival, disease-free survival, and local control rates were calculated by Kaplan-Meier method and prognostic factors were analyzed by Cox regression model. Resuits The overallS-year survival was 81%, with 94% for stage Ⅰ, 85% for stage Ⅱ, 74% for stageⅢ and 36% for stage Ⅳ. The overall 10-year survival was 69%, with 85% for stageⅠ, 61% for stage Ⅱ , 49% for stage Ⅲ and 24% for stage Ⅳ. On multivariate analysis, the Masaoka stage, surgery resection style, capsule invasion, and gender were the independent prognostic factors. Conclusions The overall 5- and 10-year survival in this group is promising. The Masaoka stage, surgery resection style, and capsule invasion are the independent prognostic factors for thymoma treated by past-operative radiotherapy.