胸腺瘤最新WHO病理分型与重症肌无力及临床分期之间的关系

The relationship of latest WHO pathological classification of thymoma with clinical stage and myasthenia gravis

目的探讨胸腺瘤最新世界卫生组织(WHO)病理分型与重症肌无力(MG)发生率和临床分期的关系及其对患者预后的影响。方法收集2009年10月至2014年10月行胸腺瘤根治手术的85例患者临床资料,采用最新WHO病理分型及传统Masaoka临床分期对患者进行分类,患者均行手术治疗,观察患者MG发生率及手术预后情况。结果 WHO病理分型中A型与AB型主要为良性病例,B型、C型以恶性病例为主。B2型更容易发生MG。WHO病理分型与Masaoka临床分型具有显著相关性(P<0.05)。经手术治疗患者治愈42例,缓解28例,进展8例,死亡7例。胸腺瘤手术方式及病理分期是影响预后的主要因素。结论最新WHO病理分型能有效区分胸腺瘤良、恶性,结合Masaoka临床分期对患者预后有指导意义。临床分期及手术对患者预后影响较大,治疗原则应根据患者良、恶性情况,采用合适的手术方式并辅以放疗、化疗,以提高治疗效果。

Objective To explore the relationship of latest WHO pathological classification of thymoma with clinical stage and myasthenia gravis（MG）. Methods The clinical data of 85 patients who received radical resection of thymoma from October 2009 to October 2014 were col-lected. The patients were classified according to the latest WHO pathological type classification and traditional Masaoka clinical stage classification respectively. The incidence of MG was observed. Results WHO pathological type A and AB thymomas were mainly benign cases,type B and C thymomas were mainly malignant cases. The incidence of MG in type B2 thymoma was higher. WHO pathological type and Masaoka clinical stage showed a significant correlation（ P 〈 0. 05）. After surgery,42 patients were cured,28 had remission,8 had progression and 7 died. Surgical method and pathological type were the major factors relevant to the prognosis. Conclusion The latest WHO pathological classification of thymoma can effectively distinguish benign from malignant thymoma;it is of significance for predicting the prognosis of the patients when combined with Masaoka clinical stage classification. The patients should be treated with appropriate surgical method and supplemented with radiotherapy and chemotherapy in order to improve the therapeutic effect.