应用糖皮质激素治疗进展期胸腺瘤的有效性分析

Analysis of the efficacy of glucocorticoid treatment in advanced thymoma

目的探讨中等剂量糖皮质激素治疗进展期胸腺瘤的临床疗效和安全性。方法回顾性分析2018年1月至2023年3月期间在首都医科大学附属北京同仁医院接受糖皮质激素(醋酸泼尼龙)治疗的56例胸腺瘤患者的临床资料,其中男33例,女23例;年龄28~72岁,平均(43.8±11.2)岁。B1型胸腺瘤16例,B2型23例,B3型17例。合并重症肌无力17例,合并纯红细胞再生障碍1例。所有患者均曾接受过放疗或化疗,但未见明显改善。患者接受中等剂量糖皮质激素50 mg/天治疗,治疗2周后行胸部CT检查评估肿瘤反应,记录肿瘤治疗效果和不良反应。结果全组56例患者,部分缓解22例,完全缓解3例,总体客观缓解率44.6%(25/56)。其中,23例B2型胸腺瘤患者,部分缓解17例,完全缓解3例,客观缓解率87.0%(20/23);16例B1型胸腺瘤患者,部分缓解5例;17例B3型胸腺瘤患者均无疗效。随访患者2~26个月,2例出现胸腺瘤复发。结论中等剂量糖皮质激素治疗晚期或侵袭性胸腺瘤安全有效,尤其适用于B2型胸腺瘤的治疗。

Objective To explore the clinical efficacy and safety of moderate-dose glucocorticoid treatment in patients with advanced thymoma.Methods A retrospective analysis was conducted on clinical data of 56 patients with thymoma who received glucocorticoid treatment at Beijing Tongren Hospital,Capital Medical University,from January 2018 to March 2023.Among them,there were 33 males and 23 females;aged from 28 to 72 years old,with a median age of(43.8±11.2)years old.There were 16 cases of type B1 thymoma,23 cases of type B2,and 17 cases of type B3.There were 17 cases with myasthenia gravis and 1 case with pure red blood cell aplasia.All patients had received radiotherapy or chemotherapy.Patients received moderate-dose glucocorticoid treatment(50 mg/day),and tumor response was evaluated by CT scan after 2 weeks of treatment.The tumor treatment effect and adverse reactions were recorded.Results Among the patients,22 cases achieved partial remission,and 3 cases achieved complete remission,resulting in an overall objective response rate(ORR)of 44.6%.Among them,23 patients had type B2 thymoma,with 17 achieving partial remission and 3 achieving complete remission,resulting in an ORR of 87.0%.Among the 16 patients with type B1 thymoma,5 achieved partial remission.No efficacy was observed in 17 patients with type B3 thymoma.The follow-up period ranged from 2 to 26 months,and 2 patients experienced thymoma recurrence.Conclusion Moderate-dose glucocorticoid treatment demonstrates effective and safe outcomes in advanced or invasive thymoma,particularly for the treatment of type B2 thymoma.