胸腺瘤临床病理的预后因素研究

An analysis of clinicopathologic features affecting prognosis of thymoma

目的 探讨胸腺瘤临床病理特点与预后的关系。 方法 对 130例胸腺瘤的重症肌无力、肿瘤大小、坏死、核分裂及包膜情况、组织学分型 (按照L B分类及M H分类 )、Masaoka临床分期等诸多因素进行分析 ,观察其 5 ,10年生存率的差别 ,所得数据进行统计学U检验及 χ2 检验。 结果重症肌无力的有无、肿瘤大小、坏死、核分裂及L B分类均与预后无关 (P >0 0 5 ) ;而肿瘤有无包膜、M H分类及临床分期与生存率有明显相关性。有包膜者 5 ,10年生存率分别为 10 0 %和 93 1% ,无包膜者分别为 5 4 4%和 40 0 % (P <0 0 5 )。按M H分类 ,髓质型 5 ,10年生存率分别为 10 0 %和 79 8% ,混合型分别为 97 5 %和 88 4% ,皮质为主型分别为 83 3%和 5 0 1% ,皮质型分别为 6 0 2 %和 2 9 9% ,分化好的胸腺癌 (WDTC)分别为 43 4%和 0 % (P <0 0 5 )。临床分期中Ⅰ期 5 ,10年生存率分别为 10 0 %和93 2 % ,Ⅱ期分别为 84 6 %和 78 4% ,Ⅲ期分别为 45 3%和 19 8% ,IV期分别为 38 0 %和 0 (P <0 0 1)。其中以细胞的异型性及有无侵犯胸腺周围器官对预后尤为重要。 结论 L B分类与预后无关 ;M H分类、临床分期与预后有关 ,尤其是瘤细胞呈多角形或大圆形、临床侵犯胸腺外器官者对预后影响较明显。

Objective To discuss the relationship between the clinicopathologic characteristics and prognosis of thymoma. Methods One hundred and thirty cases of thymoma were analyzed in terms of myasthenia gravis(MG),tumor size, necrosis, mitosis, capsule, histologic type according to the Lattes-Bernatz(L-B) classification and Muller-Hermelink(M-H) classification, staging according to Masaoka. [WT5”HZ]Results Association with MG, size of tumor, necrosis, mitosis and L-B classification were of no prognostic significance. The survival rate was higher in patients with a well encapsulated tumor. According to the M-H subtypes, the prognosis was better in patients in medullary type than in patients with cortical type thymoma. In patients with well-differentiated thymic carcinoma(WDTC), their 5-year survival rate was 43.4%, and none survived at 10 years. The survival of patients decreased with the increase in clinical stageof the disease. Cell atypia and invasion of neighboring organs were of prognostic impact on survival. Conclusion Histologic typing according to M-H classification and clinical staging according to Masaoka, cell atypia and invasion to neighboring organs are of prognostic value in patients with thymoma.