73例胸腺癌的治疗与预后分析  

Analysis of treatment and prognosis of 73 thymic carcinoma patients

作　　者：姬巍[1] 冯勤富[1] 周宗玫[1] 汪楣[1] 陈东福[1] 张宏兴[1] 肖泽芬[1] 王绿化[1] 殷蔚伯[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2006年第2期97-100,共4页Chinese Journal of Radiation Oncology

摘　　要：目的探讨胸腺癌的临床特点、治疗方法及预后。方法回顾性分析的73例胸腺癌患者中男45例,女28例,中位年龄51岁。采用Masaoka分期系统进行分期,Ⅱ期占1%,Ⅲ、Ⅳ期分别占48%、51%。接受手术治疗40例,其中6例完整切除,21例姑息手术,13例探查活检。70例接受了中位剂量60Gy的放疗,23例进行了中位4个周期的化疗。用Kaplan-Meier法计算生存率,用Logrank行差异显著性检验及生存因素分析。随访率为90%,中位随访时间14年。结果全组5、10年总生存率分别为31%、19%,中位生存时间35.1个月。Ⅲ、Ⅳ期5年生存率分别为45%、17%(P=0.002)。6例完整切除的5例存活。姑息切除术的5年生存率分别为52%,而只探查活检和未手术治疗的生存率只有14%(P=0.003)。有无化疗的5年生存率分别为28%和33%(P=0.671)。放射性心包炎和放射性肺炎发生率分别为7%、9%。在Ⅱ+Ⅲ期36例中治疗失败13例,其中局部复发4例,远处转移7例,局部复发同时远处转移2例。结论胸腺癌预后较差,Masaoka分期和手术治疗是影响生存的重要因素,放疗并发症可接受,联合化疗的作用尚需进一步研究。Objective To define the clinical characteristics, treatment method and prognosis of thymic carcinoma. Methods From June 1962 to July 2003, 73 such patients were analyzed retrospectively. All were confirmed histopathology as thymic carcinoma, including 45 males and 28 females. Masaoka＇ s system was used for staging（stage Ⅱ 1.4%, Ⅲ 47.9% and Ⅳ 50.7%）. Forty patients（55%） were treated by surgery： total resection in 6 patients（ 15% ）, subtotal resection in 21 , and exploration only 13. Seventy patients（96% ） were given radiotherapy with median of 60 Gy. Chemotherapy was instincted in 30 patients（32% ） with median of 4 cycles. Survival rate was calculated and the survival curve plotted by Kaplan-Meier method. The median follow-up time was 14 years. Results The overall 5-, 10-year survival rate was 31%, and 19%, respectively, with median survival time of 35.1 months. The 5-year survival rate was 45%, and 17% in stage Ⅲ, and Ⅳ, respectively（ P =0.002）. Five patients alive of 6 patients treated by total resection, 52% and 14% in those treated by subtotal resection and explored, unoperated groups, respectively（ P = 0.003）. The 5-year survival rate in patients treated by chemotherapy was 28% and 33% in those not treated by chemotherapy（ P = 0. 671）. Incidence of radiation pericarditis and radiation pneumonitis was 7% and 9%, respectively. Thirteen patients（36%） failed in 36 patients with stage Ⅱ,Ⅲ lesions： 4 patients by local relapse, and 7 by distant metastasis, and 2 by both local recurrence and distant metastasis. Conclusions The prognosis of thymic carcinoma is poor. Masaoka staging and type of tumor resection axe significant prognosis factors. The complication of radiotherapy was mild. The role of chemotherapy is unclear.

关 键 词：胸腺肿瘤/外科学 胸腺肿瘤/放射疗法 胸腺肿瘤/化学疗法 综合疗法 预后 

分 类 号：R736.3[医药卫生—肿瘤]