局部晚期胸腺瘤不同治疗模式疗效分析

Analysis of efficacy of different treatment modalities and prognostic factors in patients with locally advanced Masaoka‐Koga stageⅢthymoma

目的分析局部病灶侵犯严重的Masaoka‐KogaⅢ期胸腺瘤的不同治疗模式疗效及预后影响因素。方法回顾性分析2000—2018年在郑州大学附属肿瘤医院接受手术治疗的局部晚期(Ⅲ期)胸腺瘤病例,治疗及随访资料完整可分析者133例。采用Kaplan‐Meier法行生存率计算,log‐rank法行组间生存对比,Cox回归模型行多因素分析。结果中位随访时间50(3~221)个月。全组中位总生存(OS)期为51(3~221)个月,中位无病生存(DFS)期为45(2~221)个月。根治性手术组比姑息性手术组生存率更优,前者5、10年OS率分别为88.2%、74.4%,后者分别为51.8%、32.4%(P<0.001),前者5、10年DFS率分别为72.2%、45.5%,后者分别为32.3%、16.1%(P=0.001)。手术联合放疗组相比单纯手术OS更优,前者5、10年OS率分别为82.8%、64.2%,后者分别为55.8%、50.2%(P=0.033),两组的DFS未见统计学差异(P=0.176)。多因素分析显示年龄<50岁(HR=0.264,P=0.001)、手术根治性切除(HR=0.134,P<0.001)、手术联合放疗(HR=2.778,P=0.009)与较好的OS独立相关,年龄<50岁(HR=0.550,P=0.046)、手术根治性切除(HR=0.555,P=0.042)、单个器官组织受侵(HR=0.111,P=0.003)与较好的DFS独立相关。结论局部晚期胸腺瘤根治性切除者OS和DFS明显优于姑息性切除者,是影响预后的最重要因素。手术联合放疗有着更好的OS,但仍需设计严谨合理的多中心前瞻性研究评估各种治疗模式疗效及预后影响因素。

Objective To analyze the clinical efficacy of different treatment modalities and prognostic factors of patients with Masaoka-Koga stageⅢthymoma.Methods Clinical data of patients diagnosed with Masaoka-Koga stageⅢthymoma admitted to Affiliated Cancer Hospital of Zhengzhou University from January 2000 to December 2018 were analyzed retrospectively.A total of 133 patients had complete treatment and follow-up data.Kaplan-Meier method was used to calculate the cumulative survival rate,log-rank method was used to compare the survival between two groups,and Cox regression model was used for multivariate analysis.Results The median follow-up time was 50 months(3-221 months).The median overall survival(OS)was 51(3-221)months,and the median disease-free survival(DFS)was 45(2-221)months.The survival rate in the radical surgery group was better than that in the palliative surgery group.The 5-and 10-year OS rates in radical surgery group were 88.2%and 74.4%respectively,while in palliative surgery group were 51.8%and 32.4%respectively(P<0.001).The 5-and 10-year DFS rates in radical surgery group were 72.2%and 45.5%,respectively,while in palliative surgery group were 32.3%and 16.1%respectively(P=0.001).The OS in the surgery combined with radiotherapy group was better than that in the surgery alone group.The 5-and 10-year OS rates in the radical surgery group were 82.8%and 64.2%respectively,while in the palliative surgery group were 55.8%and 50.2%(P=0.033).There was no significant difference in DFS between two groups(P=0.176).Multivariate analysis showed that age<50 years old(HR=0.264,P=0.001),radical resection(HR=0.134,P<0.001),surgery combined with radiotherapy(HR=2.778,P=0.009)were independently associated with better OS.Age<50 years old(HR=0.550,P=0.046),radical resection(HR=0.555,P=0.042),and invasion of single organ(HR=0.111,P=0.003)were independently associated with better DFS.Conclusions OS and DFS in patients undergoing radical surgery are significantly better than those in their counterparts treated with palliative surgery,which is the most important factor affecting prognosis.Surgery combined with radiotherapy yields better OS.It is necessary to design a rigorous and reasonable multicenter prospective study to evaluate the efficacy of various treatment modalities and prognostic factors.