48例胸腺瘤复发转移的治疗与预后

Re-treatment and prognosis of recurrent or metastatic thymoma

目的 回顾性分析48例胸腺瘤复发转移患者的治疗结果。方法 48例符合入组条件的复发转移性胸腺瘤进入研究，收集临床资料和随访资料，采用SPSS10．0统计软件，Kaplan-Meier方法 统计总生存率和再治疗后生存率，Cox回归比例风险模型用于影响预后的多因素分析。结果 48例中，27例复发，均为纵隔内复发；26例转移。复发肿瘤手术再切除1例，手术＋术后放疗7例，放疗10例，放疗＋化疗4例，化疗5例，复发放疗中接受二程放疗者为14例。转移患者中接受放疗9例，放疗＋化疗4例，化疗12例，手术＋化疗1例。全组5、10年总生存率分别为55％、31％，中位生存期5年（1．0～32．0年）。全组再治疗后的5、10年生存率分别为38％、25％，中位生存期2．7年（0．3～14．5年）。多因素分析表明无任何因素影响再治疗后生存率。结论全组再治疗后的生存结果提示对胸腺瘤复发或转移者仍应采取积极的挽救性治疗。

Objective To analyze the treatment results of 48 patients with recurrent or metastatic thymoma. Methods Forty-eight patients with pathologically confirmed recurrent or metastatic thymoma were included in this study. The overall survival and re-treatment survival were calculated. The factors of prognosis were analyzed by Cox regression model. Results Recurrence and metastasis was found in 27 and 26 patients, repectively. All recurrence was located in the mediastinum. Tumor resection, or surgery followed by radiotherapy, radiotherapy alone, radiotherapy combined with chemotherapy or chemotherapy alone was given to 1, 7, 10, 4 and 5 patients with recurrent tumor, radiotherapy alone, radiotherapy combined with chemotherapy or chemotherapy alone was given to 9, 4 and 12 patients with metastatic tumor. The 5- year and 10-year overall survival rates were 55% and 31% ,respectively. The corresponding re-treatment overall survival was 38% and 25% ,respectively. Multivariate statistical analysis showed that no factor was independent prognostic factors. Conclusions The retreatment overall survival hints that patients with recurrent or metastastic thymoma should receive active salvage treatment.