诱导治疗后手术切除Ⅲ、Ⅳa期侵袭性胸腺瘤的临床分析

Surgical resection of stage III and IVa invasive thymoma after inductive chemoradiotherapy

目的探讨Ⅲ、Ⅳa期侵袭性胸腺瘤的诊断及术前诱导治疗策略。方法回顾分析13例Ⅲ、Ⅳa期侵袭性胸腺瘤患者的临床资料，其中Ⅲ期8例，Ⅳa期5例。肿瘤均侵犯大血管、心包或肺组织，或胸膜、心包转移。所有患者均经带芯穿刺、胸腔镜或前纵膈切开活检确诊，经长春瑞滨＋顺铂（NP）或环磷酰胺，表阿霉素，顺铂（CAP）方案术前诱导化疗3周期或同步放疗30GY，肿瘤缩小、分期降低后行完全性或姑息性手术切除。均长期随访。结果13例病理均为恶性胸腺瘤，其中B2型4例，B3型6例，C型3例。诱导化疗疗效评价，部分缓解（PR）9例，疾病稳定（SD）4例。根治性切除7例，姑息性切除2例。9例手术患者均存活超过3年，超过5年7例（77．7％），超过8年1例；4例未手术患者均在4年内死亡。结论对于无法完全切除的Ⅲ、Ⅳa期侵袭性胸腺瘤，术前诱导治疗，可使原发肿瘤缩小，控制转移灶，降低临床分期，提高手术的完全切除率，有延长生存期的趋势。

Objective To discuss the diagnosis and inductive chemoradiotherapy of stage III and stage IVa invasive thymoma. Methods Clinical data of 13 cases with incomplete resected invasive thymoma were an- alyzed retrospectively, among which 8 cases were in stage III and 5 cases in stage IVa. All the 13 cases had in- vasion of major vessels, pericardial and lung tissues, or had metastasis of pleura and pericardium. Each patient got pathological diagnosis by fine needle aspiration, video-assisted thoracoscopic biopsy or anterior mediastinal biopsy. After 3 cycles of NP or CAP inductive chemotherapy and synchronous radiotherapy, tumors shrank and got palliative or complete surgical resection. The Follow up ranged from 2.8 to 9 years. Results All the 13 eases were malignant thymoma, including 4 eases of type B2, 6 cases of type B3 and 5 eases of type C. 7 patients got radical resection and 2 got palliative resection. 9 patients survived more than 3 years after operation, 7 patients survived more than 5 years, one patient even lived 8 years, and the other 4 patients without getting surgery died in 4 years. Conclusion Inductive chemoradiotherapy could shrink stage III and stage IVa invasive thymoma, reduce clinical stage, improve the resection rate, and prolong survival.