54例侵袭性胸腺瘤患者临床预后因素分析

Analysis of clinical prognostic factors in 54 patients with invasive thymoma

目的通过分析54例侵袭性胸腺瘤患者的治疗结果,探讨影响患者预后的相关因素。方法回顾性分析54例侵袭性胸腺瘤患者的临床及随访资料,其中男27例,女27例,中位年龄50岁。手术完整切除40例,部分切除14例。依照Masaoka分期,Ⅱ期患者23例,Ⅲ期患者21例,Ⅳ期患者10例。其中Ⅱ期患者术后未行辅助放疗或化疗,Ⅲ、Ⅳ期患者中行术后辅助放疗和(或)化疗21例,10例未行术后辅助放疗或化疗。对可能影响预后的因素,采用Kaplan-Meier法和Cox比例风险模型分别进行单因素和多因素分析。结果全组3年生存率、5年生存率为:88.9%,74.1%。单因素分析示Masaoka分期、手术切除完整性、术后是否行辅助放疗和(或)化疗对生存差异有统计学意义(P<0.05)。多因素分析显示Masaoka分期、术后行辅助放疗和(或)化疗是独立预后因素(P<0.05)。结论手术切除完整性与侵袭性胸腺瘤患者的预后密切相关;Masaoka分期是影响预后的独立因素,术后辅助放疗和(或)化疗可以给患者带来显著的生存获益。

Objective To discuss the related factors affecting the prognosis of patients by analyzing the clinicopathological features and treatment results of 54 patients with invasive thymoma. Methods The clinical and follow-up data of 54 patients with invasive thymoma was analyzed retrospectively, including 27 males and 27 females with a median age of 50 years. There were 40 patients underwent complete resection, 14 patients underwent partial resection, and 23 cases with Masaoka stage lI, 21 cases with stage Ill, 10 cases with stage IV. Patients with stage 1I did not undergo adjuvant radiotherapy or chemotherapy after surgery, 21 patients received adjuvant radiotherapy and/or chemotherapy while 10 patients did not receive adjuvant treatment after surgery among the patients with stage Ill and IV. Univariate and multivariate analysis using Kaplan-Meier test and Cox regression model to determine factors which could affect the prognosis. Results The overall 3-year and 5-year survival rate were 88.9% and 74.1% respectively. On univariate analysis, The Masaoka stage, surgery resection style, adjuvant radiotherapy and/or chemotherapy for differences in survival were statistically significant （P〈 0. 05）. Multivariate analysis showed that the Masaoka stage and adjuvant radiotherapy and/or chemotherapy were the independent prognostic factors （ P 〈 0. 05 ）. Conclusions Surgery resection style is an important factor in the prognosis of patients with invasive thymoma. The Masaoka stage is the independent prognostic factors, postoperative radiotherapy and/or chemotherapy can ~ive patients a significant survival benefit.