术后放疗在Ⅰ期/Ⅱ期/Ⅲ期胸腺肿瘤中的作用--ChART回顾性数据库研究结果

Role of Postoperative Radiotherapy for Stage Ⅰ/Ⅱ/Ⅲ Thymic Tumor- Results of the ChART Retrospective Database

背景与目的胸腺肿瘤术后放疗尚存在争议,此研究目的为评价术后放疗在Ⅰ期-Ⅲ期胸腺肿瘤中的作用。方法搜索中国胸腺瘤研究协作组(Chinese Alliance of Research for Thymomas,ChART)数据库中1994年至2012年接受手术切除未行新辅助治疗的Ⅰ期-Ⅲ期胸腺肿瘤患者的资料。对临床病理资料进行单因素、多因素分析,Cox比例风险模型用于决定死亡风险比。结果 ChART数据库中Ⅰ期-Ⅲ期胸腺肿瘤共1,546例。其中649例(41.98%)接受术后放疗。术后放疗与性别、组织学类型(World Health Organization,WHO)、胸腺切除程度、是否完全切除、Masaoka-Koga分期及辅助化疗相关。手术后辅助放疗患者5年、10年总生存和无瘤生存分别为90%和80%、81%和63%,而单纯手术者5年、10年总生存和无瘤生存分别为96%和95%、92%和90%,两组生存有统计学差异(P=0.001,P<0.001)。单因素表明年龄、组织学分类(WHO)、Masaoka-Koga分期、是否完全切除和术后放疗与总生存相关。多因素分析提示组织学分类(WHO)(P=0.001)、Masaoka-Koga分期(P=0.029)和是否完全切除(P=0.003)是总生存的独立预后因素。单因素分析表明性别、重症肌无力、组织学分类、Masaoka-Koga分期、手术方式、术后放疗和是否完全切除与无瘤生存相关。多因素分析表明组织学类型(P<0.001)、Masaoka-Koga分期(P=0.005)和是否完全切除(P=0.006)是无瘤生存的独立预后因素。亚组分析表明不完全切除患者接受术后放疗可以提高总生存和无瘤生存(P=0.010,P=0.017)。然而,完全切除者接受术后放疗则会降低总生存和无瘤生存(P<0.001,P<0.001)。结论此回顾性研究表明不完全切除Ⅰ期-Ⅲ期胸腺肿瘤患者术后放疗可以提高总生存和无瘤生存。但是,对于完全切除患者,术后放疗总体上并未显示出生存获益。

Background and objectivePostoperative radiotherapy （PORT） for thymic tumor is still controversial. The object of the study is to evaluate the role of PORT for stage I/II/III thymic tumor.MethodsThe database of Chinese Al-liance of Research for Thymomas （ChART） was retrieved for patients with stage I/II/III thymic tumor who underwent surgi-cal therapy without neoajuvant therapy between 1994 and 2012. Univariate and multivariate survival analyses were performed. Cox proportional hazard model was used to determine the hazard ratio for death.Results 1,546 stage I/II/III patients were identiifed from ChART database. Among these patients, 649 （41.98%） underwent PORT. PORT was associated with gender, histologic type （World Health Organization, WHO）, surgical extent, complete resection, Masaoka stage and adjuvant che-motherapy. The 5-yr and 10-yr overall survival （OS） rates and disease-free survival （DFS） rate for patients underwent surgery followed by PORT were 90% and 80%, 81% and 63%, comparing with 96% and 95%, 92% and 90% for patients underwent surgery alone （P=0.001,P〈0.001） respectively. In univariate analysis, age, histologic type （WHO）, Masaoka stage, complete-ness of resection, and PORT were associated with OS. Multivariable analysis showed that histologic type （WHO）（P=0.001）, Masaoka stage （P=0.029） and completeness of resection （P=0.003） were independently prognostic factors of OS. In univari-ate analysis, gender, myasthenia gravis, histologic type （WHO）, Masaoka stage, surgical approach, PORT and completeness of resection were associated with DFS. Multivariable analysis showed that histologic type （WHO） （P〈0.001）, Masaoka stage （P=0.005） and completeness of resection （P=0.006） were independently prognostic factors of DFS. Subgroup analysis showed that patients with incomplete resection underwent PORT achieved the better OS and DFS （P=0.010, 0.017, respectively）. However, patients with complete resection underwent PORT had the worse OS and DFS （P〈0.001,P〈0.001, respectively）. ConclusionThe current retrospective study indicated that PORT atfer incomplete resection could improve OS and DFS for patients with stage I/II/III thymic tumor. But for those atfer complete resection, PORT may not help improve prognosis on the whole.