B型胸腺上皮肿瘤外科治疗预后的影响因素研究

Influence Factors of Prognosis of Surgical Treatment of B-type Thymic Epithelial Tumor

目的探讨B型胸腺上皮肿瘤(TET)患者外科治疗预后的影响因素。方法选取2004——2006年在河北医科大学第四医院胸外科住院并行手术治疗的B型TET患者78例,按照WHO组织学分型标准将患者分为B1型组(n=33)、B2型组(n=22)和B3型组(n=23)。患者行完整切除术或姑息减瘤术或开胸探查术。术后对患者进行随访,随访截至2016-04-30。应用Kaplan-Meier方法进行生存分析,Log-rank检验比较生存率,Cox比例风险回归模型分析影响预后的因素。结果 B1型组手术完整切除率为97.0%(32/33),B2型组手术完整切除率为90.9%(20/22),B3型组手术完整切除率为69.6%(16/23),3组手术完整切除率比较,差异有统计学意义(χ~2=9.488,P<0.01)。随访结束时有35例患者死亡。患者术后5年、10年生存率分别为67.0%和51.0%。不同性别、年龄、有无重症肌无力(MG)患者预后比较,差异均无统计学意义(P>0.05);不同WHO组织学分型、Masaoka分期、是否完整切除患者预后比较,差异均有统计学意义(P<0.05)。Cox比例风险回归模型分析结果显示,WHO组织学分型(HR=2.991,95%CI(1.592,5.871),P=0.032]、Masaoka分期(HR=2.304,95%CI(1.074,2.981),P<0.001]、是否完整切除[HR=3.179,95%CI(1.511,4.832),P=0.025]是B型TET患者预后的独立影响因素。结论 WHO组织学分型、Masaoka分期以及是否完整切除是B型TET患者预后的独立影响因素。

Objective To discuss influence factors of prognosis of surgical treatment of patients with B-type thymic epithelial tumors（TET）.Methods A total of 78 inpatients with B-type TET who had undergone operative treatment from 2004 to 2006 in Department of Thoracic Surgery of Fourth Hospital of Hebei Medical University were selected.All the patients were divided into B1-type group（n = 33）,B2-type group（n = 22） and B3-type group（n = 23） according to the histological classification standard of WHO.All patients underwent radical resection or palliative cytoreductive surgery or exploratory thoracotomy.The followed up of patients were not ended until April 30 th in 2016.Kaplan-Meier method was used for survival analysis,Log-rank test was applied to compare the survival rate,and Cox proportional hazards regression model was adopted to analyze the influence factors of prognosis.Results The operative resection rate in Bl-type group was 97.0%（32/33）,B2-type group was 90.9%（20/22）,B3-type group was 69.6%（16/23）.There was significant difference in operative resection among three groups（χ^2=9.488,P〈0.01）.After the follow-up,35 patients died.The survival rates of patients 5 years and10 years after operation were 67.0%and 51.0%respectively.There were no significant differences in the prognosis of patients with different gender,age and combination of MG（P〈0.05）;there were significant differences in the prognosis of patients with different histological classifications of WHO,Masaoka stages,undergoing radical resection or not（P〈0.05）.Cox proportional hazards regression model analysis showed that histological classifications of WHO（HR =2.991,95%CI（1.592,5.871）,P= 0.032],Masaoka stages（HR = 2.304,95%CI（1.074,2.981）,P〈0.001） and radical resection or not during operation（HR = 3.179,95%CI（1.511,4.832）,P = 0.025） were independent factors of the prognosis of patients with B-type TET.Conclusion The histological classifications of WHO,Masaoka stages and radical resection or not during operation are the independent factors of the prognosis of patients with B-type TET.