化疗在胸腺肿瘤治疗中的临床价值:中国胸腺肿瘤研究协作组回顾性研究  

Clinical value of chemotherapy for thymictumors:a retrospective analysis based on the results of the Chinese Alliance of Research for Thymomas database

作　　者：马可[1] 韩泳涛[1] 陈克能[2] 方文涛[3] 无 

机构地区：[1]四川省肿瘤医院胸外科,成都610041 [2]北京大学附属肿瘤医院胸外科,100142 [3]上海交通大学附属胸科医院胸外科,200030 [4]中国胸腺肿瘤研究协作组

出　　处：《中华胸部外科电子杂志》2015年第1期13-19,共7页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的分析探讨化疗在胸腺肿瘤治疗中的临床应用价值。方法回顾性分析中国胸腺肿瘤研究协作组（the Chinese Alliance of Research for Thymomas, CHART）数据库中1994年3月至2012年12月纳入的Masaoka Ⅲ／Ⅳa期及胸腺肿瘤化疗病例739例，初步评估不同模式化疗的临床价值，采用Kaplan-Meier法绘制不同亚组患者生存曲线，分析影响预后的因素。结果Masaoka-Koga分期、手术的根治性和病理学类型是影响患者长期生存的主要因素。初始化疗有效率50．8％0（30／59），客观缓解率11．9％（7／59）。初始化疗使R0切除率从66．6％（397／596）提高至72．9％（43／59）。Masaoka-Koga Ⅲ／Ⅳ期胸腺癌未术后化疗组与术后化疗组5年、10年生存率分别为71．0％、66．6％和53．5％、42．6％，两组间差异无统计学意义（χ^2=0．003，P=0．953）。Masaoka-KogaⅣ期胸腺瘤未术后化疗组与术后化疗组5年生存率分别为85．7％、76．1％，两组间差异无统计学意义（χ^2=0．030，P=0．862）。Masaoka-KogaⅢ胸腺瘤患者未术后化疗组和术后化疗组5年、10年生存率分别为92．1％、65．0％和88．1％、59．6％，未术后化疗组生存率显著优于术后化疗组（χ^2=13．294，P=0．000）。Masaoka-KogaⅢ／Ⅳ期胸腺瘤R0切除后患者未术后化疗组和术后化疗组5年生存率分别为92．8％和67．2％，未术后化疗组生存率也显著优于术后化疗组（χ^2=10．856，P=0．001）。结论初始化疗有提高R0切除率趋势，术后化疗未能改善胸腺肿瘤的总体预后，对于MasaokaⅢ期胸腺瘤和局部晚期R0切除的胸腺肿瘤患者术后化疗无益。Objective To explore the clinical value of chemotherapy in the treatment of thymie tumors. Methods 739 patients with Masaoka stage Ⅲ/Ⅳa or the chemotherapy cases between March 1994 and December 2012 were retrospectively analyzed based on the Chinese Alliance of Research for Thymomas（ChART）database. The clinical value of different modes of chemotherapy was estimated, the survival curves were drawn according to different subgroups, and the factors affecting the prognosis were analyzed. Results The Masaoka-Koga stage, completion of resection and pathological type were the main influencing factors of long-term survival. The efficiency of primary chemotherapy was 50.8% （30/ 59）, and the objective response rate was 11.9% （7/59）. The primary chemotherapy improved complete resection rate from 66.6%（397/596） to 72.9%（43/59）. The 5-year survival and 10-year survival of non-postoperative chemotherapy group and postoperative chemotherapy group in patients with Masaoka- Koga Ⅲ/Ⅳ thymic carcinoma were 71.0% vs 66.6% and 53.5%0 vs 42.6%, respectivcly（χ^2 =0. 003, P= 0.953）. The 5-year survival of non-postoperative chemotherapy group and postoperative chemotherapy group in patients with stage IV thymic tumor were 85.7% and 76.1%, respectively（χ^2 = 0. 030, P=0. 862）. The 5-year survival and 10-year survival of non-postoperative chemotherapy group and postoperative chemotherapy group in patients with stage Ⅲ thymoma were 92.1% vs 65.0% and 88.1% vs 59.6%, respectively （ χ^2= 13. 294, P= 0. 000）. For the patients with complete resected thymoma in stage Ⅲ and Ⅳ, the 5-year survival of patients without and with postoperative chemotherapy were 92.8% and 67.2~, respectively（χ^2= 10. 856, P=0. 001）. Conclusions Primary chemotherapy can slightly improve the complete resection rate, while postoperative chemotherapy cannot improve the long-term outcomes of thymic tumors. Postoperative chemotherapy does no good to the Masaoka Ⅱ thymoma and thymic tumor with localized advanced complete

关 键 词：胸腺肿瘤 化疗 手术 预后 

分 类 号：R736.3[医药卫生—肿瘤]