45例晚期胸腺癌的临床分析

Clinical Analysis of 45 Patients with Thymic Carcinoma

目的:探讨晚期胸腺癌的预后影响因素。方法:回顾性分析1992年1月～2003年8月45例晚期胸腺癌患者,其中男33例,女12例,中位年龄为49岁。按Masaoka标准进行分期:Ⅲ期29例,Ⅳ期16例(Ⅵa期13例,Ⅵb期3例)。并根据WHO(2004)分类标准对肿瘤进行分类,其中低度恶性25例,高度恶性20例。所有病人均接受手术或SCT引导下穿刺病理活检,其中完全手术切除5例,不完全切除21例,仅做活检19例。42例患者接受放射治疗,中位剂量为60Gy。37例为常规放射治疗,照射范围分为局部照射(14例)和扩大照射(23例)。局部照射指瘤床边缘外放1～2cm2(术前影像为准),扩大照射包括全纵隔全心包照射(加或不加锁骨上区预防照射)。5例患者接受立体定向放射治疗,31例患者接受化学药物治疗,化疗药物包括顺铂,VP-16,环磷酰胺,氟尿嘧啶,紫杉醇等。结果:随访率为95.6%,中位随访时间为59个月。总体三年生存率为57.8%,中位生存时间为45个月。通过单因素分析组织学分型,临床分期影响其预后。完全手术切除与非完全手术切除(包括活检)的三年生存率分别为80.9%、55.0%。放疗患者中常规放射治疗与立体定向放射治疗的三年生存率59.5%、80%,有统计学意义。晚期患者中化疗组与非化疗组的三年生存率分别为64.5%、42.9%,无统计学意义。但对于Ⅳ期患者,有统计学意义,化疗也影响其预后。结论:Ⅲ、Ⅳ期胸腺癌患者应尽可能做局部完全手术切除,并行常规术后放射治疗或立体定向放射治疗,必要时结合化学药物治疗。对于Ⅳ期患者,应结合化学药物治疗。

To retrospeetively evaluate the prognostic factors for advanced thymic carcinoma. Methods： The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 stage Ⅲ patients and 16 stage Ⅳ patients （13 stage IVa patients and 3 stage Ⅳb patients）. According to the World Heath Organization Histological Criteria （2004）, 25 cases were identified as low-grade and 20 cases were identified as high-grade, All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21 patients under-went subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation. Local irradiation volume covered the primary tumor bed and approximately 1-2cm^2 surrounding the tumor （according to preoperative imaging）. Expanded irradiation volume covered the full mediastinal and pericardium areas （with or without prophylactic, irradiation in the supraclavicular area）. Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemothcrapeutics, including Cisplatin, VP-16, Endoxan, 5-FU and taxol. Results： The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. U-nivariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors. The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy alone. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9% in patients treated without simultaneous chemotherapy （P〉0.05）. Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for stage Ⅳ patients than radiation treatment and surgery without chemotherapy（P〈0.05）. Conclusion： For patients with stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with stage Ⅳ thymie carcinoma, chemotherapy is necessary.