胸腺癌患者术后预后因素的临床分析

Prognostic factors of patients with thymic carcinoma after surgery

目的分析胸腺癌患者手术预后影响因素,预测手术后患者的生存期。方法回顾性分析1994-01-06-2013-01-14山东大学附属省立医院经手术治疗的351例胸腺上皮肿瘤患者临床资料,其中58例经病理确诊为胸腺癌,分析58例患者临床病理特点、治疗方法及随访情况。采用Kaplan-Meier法分析生存期,并进行单因素和多因素分析以确定影响预后的因素。结果总的3、5和10年生存率分别为69.0%、43.1%和12.1%。Log-rank检验显示,Masaoka分期(P<0.001)、组织学类型(P<0.001)、手术切除的完整性(P<0.001)、大血管侵犯(P<0.001)和存在的症状(P<0.05)是影响预后的重要的因素。而肿瘤大小(P=0.086)、年龄(P=0.677)、性别(P=0.706)、吸烟(P=0.065)和饮酒(P=0.875)与预后的关系不大。Cox比例风险回归模型显示,Masaoka分期(HR=15.640,P<0.001)和手术切除的完整性(HR=18.303,P<0.001)是重要的独立预后因素。结论手术切除完整性和Masaoka分期是影响胸腺癌患者术后生存的独立预后因素。

OBJECTIVE To analyze the prognostic factors to predict the survival time of thymic carcinoma patients after surgery.METHODS We reviewed 351 cases of thymic epithelial tumor treated with surgery at the Provincial Hospital Affiliated to Shandong University from January 6,1994 to January 14,2013.A total of 58 patients were histopathologically reconfirmed as thymic carcinoma.Clinicopathological characteristics and treatment modalities were reviewed.Survival time was analyzed using the Kaplan-Meier method.Univariate and multivariate analysis were performed to identify prognostic factors.RETSULTS The overall 3-,5-,and 10-years survival rates was 69.0%,43.1%,and 12.1%,respectively.The Log-rank test revealed that Masaoka stage（P〈0.001）,histology group（P〈0.001）,completeness of the resection（P〈0.001）,great vessel invasion（P〈0.001）,and presence of symptoms（P〈0.05）were significant prognostic factors in all patients.Tumor size（P=0.086）,age（P=0.677）,sex（P=0.706）,smoking（P=0.065）and alcohol（P=0.875）were not prognostic factors.Cox proportional hazards regression model showed that Masaoka stage（HR=15.640,P〈0.001）and completeness of the resection（HR=18.303,P〈0.001）were the only independent prognostic factors.CONCLUSION The Masaoka stage and completeness of resection are independent prognostic factors that predictes long-term survival of patients with thymic carcinoma treated with surgery.