胸腺瘤的诊断、治疗和预后

Diagnosis,treatment and prognosis of thymoma: analysis of 116 cases

目的 探讨影响胸腺瘤的诊断、治疗及预后的相关因素。 方法 回顾性分析 116例胸腺瘤的临床资料 ,运用寿命表法计算其生存率 ,以生存、复发或转移率为指标 ,进行研究。 结果胸部X线等影像学检查是本病诊断的主要手段 ,重症肌无力是最常见的伴随疾病 ,发生率为 2 5 0 %(2 9/ 116 )。扩大胸腺及胸腺瘤切除可降低Ⅰ、Ⅱ期肿瘤的复发率 (χ2 =4 94 1P =0 0 2 19) ,放疗和化疗等综合治疗可以提高疗效。组织学分型 (M H法 )与临床分期有明显的相关性 ,能更有效地反映胸腺瘤的侵袭性 (γ =0 385 ,P =0 0 0 7,)。本组患者 3、5、10年生存率分别为 81 2 %、6 7 9%和 4 0 5 % ,肿瘤分期与生存率明显呈负相关 (γ =- 0 897,P =0 0 0 0 )。 结论 肿瘤的组织类型、病理分期及综合治疗方法是影响患者预后的重要因素 。

Objectives To study the diagnosis and treatment of thymoma and to assess prognosis factors. Methods The clinical data on 116 patients with thymoma were collected. A retrospective analysis was performed by comparison of their survival rates computed by the actuarial method and rate of recurrence and metastasis. Results Chest radiograph was used chiefly for the preoperative diagnosis of thymoma; myasthenia gravis (MG) (25 0%, 29/116) was the most common paraneoplastic disease. An extensive and radical resection was carried out to reduce the recurrence rate of thymoma with stageⅠ and stageⅡ(χ 2=4 941 P =0 021 9).The survival time was prolonged by postoperative radiotherapy and chemotherapy. A strong correlation was noted between the clinical stage and histologic subtype of M H classfication, by which the invasive behavior of thymoma was predicted ( r =0 385, P =0 007). The 3 ,5 , and 10 year survival rates were 81 2%, 67 9% and 40 5%,respectively. Statistical analysis showed a significant negative correlation between stage and survival rate ( r =-0 897, P =0 0000). Conclusion The prognosis of thymoma depends mainly on the histologic subtype, clinical stage and multimodality treatment rather than paraneoplastic diseases.