胸腺瘤的临床病理特征和预后

Clinico pathological characteristics and prognosis of thymoma: an analysis of 159 cases

目的 分析胸腺瘤的临床病理特点，探讨有关外科治疗及预后相关因素。方法 将１５９ 例胸腺瘤临床资料输入计算机，采用Ｃｏｘ 模型进行预后多因素分析，并运用寿命表法计算生存率，以生存率、复发转移率为指标，进行回顾性研究。结果 （１） 本组３，５ ，１０ 年生存率分别为７８．９ ％ 、６３．７ ％ 和４６．３ ％ 。姑息切除后加放射治疗，患者３ 年生存率为１００％ 。（２） 发病年龄、肿瘤部位和Ｘ线密度在鉴别诊断中起重要作用。（３） 上皮细胞为主型晚期病例数较其他组织学类型多（ Ｐ＜ ０．０１） 。（４） 肿瘤包膜未受侵但不完整或无包膜组预后较Ⅰ期差（ Ｐ＜ ０．０５） 。（５） 经多因素分析，手术方式（ ＯＲ＝２ ．１０） 、临床病理分期（ ＯＲ＝ １．７３）为影响预后的重要因素。术后肌无力危象是导致手术死亡的首要因素。性别、症状及组织学分类对预后影响不大。（６） 术后各期均有可能局部复发和远处转移，病期越晚复发转移率越高。结论 外科治疗应争取根治性切除肿瘤，以减少复发。姑息切除加术后放疗有助于提高疗效。

Objective To investigate the clinicopathologic features of thymoma and assess prognostic factors. Methods Data of 159 patients operated for thymoma were collected. A retrospective analysis was performed, through comparison of survival rate computed by the actuarial method and rate of recurrence and metastasis.Results (1) The 3 , 5 , and 10 year survival rate was 78.9%, 63.7% and 46.3%, respectively. All patients treated by subtotal thymoma resection with postoperative radiotherapy survived more than 3 years.(2) Patient's age, location and image density of tumor play important role in differential diagnosis.(3) Tumors with epithelial predominance were more frequently seen in late stage than those of other histologic types( P <0.01).(4) The prognosis of patients whose tumors had incomplete or no capsule was poor as compared to that of stage Ⅰ tumor ( P <0.05).(5)According to multivariate analysis, the most important prognostic variables included completeness of resection ( OR =2.10) and clinicopathologic stage ( OR =1.73). Myasthenic crisis was the most important factor influencing operative death. Sex, symptoms and histologic classification did not influence prognosis.(6)Recurrence and metastasis occurred in all stages, but more frequent in the later stages of the disease.Conclusion Complete resection helps decrease recurrence of thymoma. Prognosis of patients receiving palliative resection of thymoma may be improved by postoperative radiotherapy.