胸腺瘤术前CT分期与术后Masaoka临床分期相关性分析

Preoperative CT findings of thymomas:correlated with postoperative Masaoka clinical stage

目的探讨胸腺瘤术前CT分期与术后Masaoka临床分期之间的相关性。方法回顾分析比较105例胸腺瘤患者术前CT特征、临床特点及术后Masaoka临床分期。结果病变CT分期与Masaoka临床分期有明显关系,包括病灶大小(P=0.028)、形态(P<0.001)、密度(P=0.002)、包膜完整性(P<0.001)以及周边组织受累情况(P<0.001)。通过CT发现34.78% MasaokaⅠ期病灶<5cm,而仅有8.70% MasaokaⅠ期病灶≥10cm;相反,仅有16.67%的MasaokaⅣ期病灶<5cm,而有37.50% MasaokaⅣ期病灶≥10cm。MasaokaⅠ期和Ⅱ期病灶多呈圆形或卵圆形、边界清楚、密度均匀;MasaokaⅢ期和Ⅳ期肿块形态不规则、密度不均匀、包膜不完整;Ⅲ期(80.00%)和Ⅳ期(87.50%)侵袭性肿块明显多于Ⅰ期(0%)和Ⅱ期(40.00%)。MasaokaⅠ期与CTⅠ期病灶的一致性明显高于其他分期(Kappa=0.884)。重症肌无力发生率在各Masaoka临床分期之间无差异。结论胸腺瘤术前CT分期与术后Masaoka临床分期一致性较高,有利于患者治疗方案的制订及对远期疗效的评估。

Objective To investigate the relationships between preoperative computed tomography （CT） staging and postoperative 1 Masaoka clinical staging of thymomas. Methods 105 patients who had undergone surgery were retrospectively reviewed for their preoperative CT findings and postoperative clinical characteristics. Surgical findings were evaluated according to the Masaoka staging system. Results A significant association was observed between staging by CT and Masaoka clinical data especially of features including tumor size （ P = 0. 0277 ）, tumor shape （ P 〈 0. 001 ）, tumor density （ P =0. 0018 ）, capsule completeness （ P 〈 0. 001 ）, and the status of surrounding tissues involvement（P 〈 0. 001 ）. Based on the CT findings, there were 34. 78% of Masaoka stage 1 patients who had a tumor size 〈 5 cm as compared to 16. 67% of stage Ⅳpatients. Only 8.70% of Masaoka stage Ⅰ patients had a tumor size ≥10 cm as compared to 37.50% of stage Ⅳ patients. Stage Ⅰ or Ⅱ thymomas were mostly oval or round,had smooth edges and even density, while stage Ⅲ or Ⅳ thymomas were usually irregularly shaped or lobulated with uneven density and incomplete capsule. Invasive tumors were more frequently found in stages Ⅲ （80. 00% ） and Ⅳ （ 87.50% ） than in stages Ⅰ （0） and Ⅱ （ 40.00% ）. The incidence of myasthenia gravis was comparable in different stages. Consistency between CT and Masaoka clinical stages was higher in stage Ⅰ （ Kappa = 0. 884）than other stages. Conclusions Preoperative stages of thymoma by CT are consistent with Masaoka clinical stages by surgical findings, and are beneficial for determining proper management and prognosis of thymoma patients.