胸腺上皮肿瘤89例临床分析

摘要

背景与目的:胸腺上皮肿瘤(thymic epithelial tumors,TET)是前纵隔最常见的肿瘤之一,临床上通常根据Masaoka分期及WHO组织学分型判定其良、恶性.本文通过对89例TET患者进行临床分析,探讨WHO组织学分型与Masaoka分期之间的相关性,研究不同分期、分型TET的手术特点及预后影响因素.方法:分析1999年3月～2009年6月经手术确诊的89例TET患者的临床资料,并进行随访,分析TET Masaoka分期、WHO组织学分型及手术切除情况与生存率之间的关系.结果:本组Masaoka分期:I期39例(43.8%),Ⅱ期15例(16.9%),Ⅲ期31例(34.8%),Ⅳa期4例(4.5%),无Ⅳb期患者;其5年生存率分别为I期100%;Ⅱ期92.9%;Ⅲ期62.1%;Ⅳ期25.0%o WHO组织学分型:A型7例(7.9%),AB型16例(18.0%),Bl型13例(14.6%),B2型18例(20.2%),B3型13例(14.6%),C型22例(24.7%);其5年生存率分别为100%,100%,100%,94.1%,80.0%和54.5%.手术完全切除69例(86.3%),不完全切除或活检11例(13.8%),其5年生存率分别为92.8%和9.1%0Masaoka分期、WHO组织学分型、手术切除的完整性是影响患者预后的独立预测因素.结论:WHO组织学分型与Masaoka分期有高度相关性(P=0.000),两者皆可指导临床治疗.手术完全切除是TET最主要的治疗方法.%Background and purpose: Thymic epithelial tumors (TET) is the most common tumor of anterior mediastinum tumors. The aim of this study was to clinically evaluate whether this tumor is benign or malignant in the Masaoka stage and WHO histologic subtype. This study also explored the relationship between the WHO histologic subtype and the Masaoka stage, and analyzed the prognostic factors in thymic epithelial tumors. Methods: Eightynine cases of surgically treated TET were retrospectively reviewed according to current World Health Organization (WHO) criteria for TET classification and modified Masaoka staging system. Results: 39 (43.8％) patients were in stage Ⅰ, 15 (16.9％) patients were in stage Ⅱ, 31 (34.8％) patients were in stage Ⅲ, 4 (4.5％) patients were in stage Ⅳa, and no patients were stage Ⅳb. Tumor-related at 5-year survival were 100％ in stage Ⅰ, 92.9％ in stage Ⅱ, 62.1％in stage Ⅲ, and 25.0％ in stage Ⅳa, respectively. There were 7 (7.9％) type A tumors, 16 (18.0％) type AB tumors,13 (14.6％) type B1 tumors, 18 (20.2％) type B2 tumors, 13 (14.6％) type B3 tumors, and 22 (24.7％) type C tumors.Tumor-related survival at 5 years were 100％ in type A, type AB and type B1, 94.1％ in type B2, 80.0％ in type B3,54.5％ in type C, respectively. Sixty-nine (86.3％) patients underment completed resection, and 11 (13.8％) patients had incomplete resection. Tumor-related survival at 5 years was 92.8％ and 9.1％, respectively. Masaoka staging, WHO classification and complete resection were identified as independent prognostic factors. Conclusion: The WHO histologic subtype closely correlated with the Masaoka stage (P=0.000). Both WHO histologic subtypes and Masaoka stages can guide therapy. Complete resection is the most important form of therapy for curing TET.