胸腔镜与开放手术治疗临床早期胸腺恶性肿瘤的围手术期效果及长期生存率的比较

Perioperative Outcomes and Long-term Survival in Clinically Early-stage Thymic Malignancies:Video-assisted Thoracoscopic Thymectomy versus Open Approaches

背景与目的胸腔镜胸腺切除术相比开放手术治疗早期(Masaoka-Koga Ⅰ期或Ⅱ期)胸腺恶性肿瘤在理论上具有优势,然而尚未有研究报道其在长期生存率方面的差异。本研究基于中国胸腺肿瘤研究协作组(Chinese Alliance for Research in Thymomas,ChART)的数据库对此进行了研究。方法以数据库中1994年到2012年间的1,117例早期(Masaoka-Koga Ⅰ期或Ⅱ期)胸腺恶性肿瘤患者为研究对象。其中241例行胸腔镜胸腺切除术,876例行开放手术。采用单因素分析比较两组的临床资料与围手术期结果方面的差异。采用多因素分析明确影响长期预后的相关因素。结果与开放手术组相比,胸腔镜组的全胸腺切除比例更高(80.5%vs73.9%,P=0.028),根治性切除率更高(98.8%vs 88.7%,P<0.000),而复发率更低(2.9%vs 16.0%,P<0.001),5年无瘤生存率更高(92%vs 83%,P=0.011),而两组的5年生存率接近(92%vs 92%,P=0.15)。Cox比例风险模型分析显示WHO分型、Masaoka-Koga分期和术后辅助治疗是影响胸腺恶性肿瘤长期生存的独立因素。结论胸腔镜胸腺切除术是治疗早期胸腺恶性肿瘤安全有效的方法,与开放手术相比其围手术期效果更好,肿瘤学疗效一致。

Background and objectiveVideo-assisted thoracoscopic surgery （VATS） theoretically offers advantages over open thymectomy for clinically early-stage （Masaoka-Koga stage I and II） thymic malignancies. However, longterm outcomes have not been well studied. We compared the postoperative outcomes and survival from a cohort study based on the database of the Chinese Alliance for Research in Thymomas （ChART）.MethodsBetween 1994 and 2012, data of 1,117 patients hav-ing surgery for clinically early-stage （Masaoka-Koga stage I and II） tumors were enrolled for the study. Among them, 241 cases underwent VATS thymectomy （VATS group）, while 876 cases underwent open thymectomy （Open group）. Univariate analyses were used to compare the clinical character and perioperative outcomes between the two groups. And multivariate analysis was performed to determine the independent predictive factors for long-term survival.Results Compared with the Open group, the VATS group had higher percentage of total thymectomy （80.5%vs 73.9%,P=0.028）, resection rate （98.8%vs 88.7%,P〈0.001） and less recurrence （2.9%vs 16.0%,P〈0.001）. Five-year overall survival was 92% atfer VATS and 92% atfer open thymectomy, with no signiifcant difference between the two groups （P=0.15）. However, 5-year disease free survival were 92% in VATS group and 83% in Open group （P=0.011）.Cox proportional hazards model revealed that WHO classiifcation, Masaoka-Koga stage and adjuvant therapy were independent predictive factors for overall survival, while surgical approach had no signiifcant impact on long-term outcome.ConclusionhTis study suggests that VATS thymectomy is an effective approach for clinically early-stage thymic malig-nancies. And it may offer better perioperative outcomes, as well as equal oncological survival.