胸腺瘤WHO组织学分型与胸腺瘤诊治的关系

WHO Histologic Classification of Thymoma and its Relationship with Thymoma Diagnosis and Treatment

目的探讨胸腺瘤WHO组织学分型(WHO histologic classification of thymoma)在胸腺瘤诊治中的临床意义。方法采用胸腺瘤WHO组织学分型对79例胸腺瘤病例进行病理分类,比较不同病理类型与伴发重症肌无力(Myasthe-niagravis,MG)、Masaoka分期及临床预后的关系。结果在各型胸腺瘤中,A、AB、B1、B2、B3和C型伴发MG分别为37.5%(3/8)、53.8%(7/13)、70%(14/20)、88.5%(23/26)、33.3%(3/9)、0%(0/3)。B型胸腺瘤伴发MG为72.7%(40/55),明显高于A型和AB型胸腺瘤的47.6%(10/21,P<0.05)。B2胸腺瘤伴发MG明显高于B1、B3型(P<0.01)。在各型胸腺瘤中,A、AB、B1、B2、B3、C型胸腺瘤发生浸润或转移者分别为12.5%(1/8)、23.1%(3/13)、75%(15/20)、84.6%(22/26)、100%(9/9)、100%(3/3)。B型胸腺瘤浸润性明显高于A型、AB型胸腺瘤(P<0.01)。在各型胸腺瘤中,以C型胸腺瘤浸润性最强。在所有胸腺瘤中,5年总生存率为72.4%。A型、AB型5年生存率为93.5%,B型胸腺瘤为71.8%,其中B1型、B2型、B3型分别为81.6%、70.4%和56.4%。A型、AB型胸腺瘤5年生存期明显长于B型(P<0.05)。COX回归模型多因素分析发现胸腺瘤WHO组织学分型、Masaoka分期、手术切除方式是影响胸腺瘤预后的独立危险因素。结论胸腺瘤WHO组织学分型与伴发MG相关,反映肿瘤上皮细胞的浸润功能,可以评价患者预后。

Objective To explore the clinical significance of WHO histologic classification of thymoma in diagnosing and treating thymomas.Methods To review the pathological sections of 79 patients with thymoma from 1996-2008 using WHO classification（1999）,the statistical software was used to analyze the relationship among the WHO classification,MG,clinical stages and prognosis.Results MG were associated with 37.5%（3/8）,53.8%（7/13）,70.0%（14/20）,88.5%（23/26）,33.3%（3/9）,0%（0/3） patients in type A,AB,B1,B2,B3 and C thymomas,respectively.Type B associated with MG was 72.7%（40/55）,which was higher than 47.6%（10/21）of type A and type B（P0.05）.Type B2 associated with MG was higher than type B1,B3（P0.01）.The invasiveness of tumors was 12.5%（1/8）,23.1%（3/13）,75.0%（15/20）,84.6%（22/26）,100.0%（9/9）,100.0%（3/3） for type A,AB,B1,B2,B3 and C thymomas respectively.Type B thymomas were more invasive than type A and AB（P0.01）.Type C were the most invasive in all the thymomas.Total 5-year survival rate in all the thymomas was 72.4%.5-year survival rate was 93.5%,71.8% in type A,type AB and type B,respectively.5-year survival rate was 81.6%、70.4% and 56.4% in type B1,B2,B3,respectively.5-year survival in type A and type AB was longer than type B（P0.05）.By multivariate analysis,WHO histologic classification,Masaoka staging system and complete resection were significant independent prognostic factors.Conclusion WHO histologic classification of thymoma was associated with MG,reflected the invasive function of thymic epithelial tumors,may evaluate the prognosis of patients with thymoma.