胸腔镜与开放手术治疗临床早期胸腺恶性肿瘤的围手术期效果及长期生存率的比较  

Perioperative Outcomes and Long-term Survival in Clinically Early-stage Thymic Malignancies:Video-assisted Thoracoscopic Thymectomy versus Open Approaches

作　　者：汪灏[1] 谷志涛[2] 丁建勇[1] 谭黎杰[1] 傅剑华[3] 沈毅[4] 魏煜程 张鹏[5] 韩泳涛[6] 陈椿[7] 张仁泉[8] 李印 陈克能[10] 陈和忠[11] 刘永煜 崔有斌[13] 王允[14] 庞烈文[15] 于振涛[16] 周鑫明[17] 柳阳春[18] 刘媛[2] 方文涛[2] 中国胸腺肿瘤协作组成员 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032 [2]上海交通大学附属上海胸科医院,上海200030 [3]中山大学附属肿瘤医院胸外科,广州510060 [4]青岛大学医学院附属医院胸外科,266001 [5]天津医科大学附属总医院胸外科,天津300052 [6]四川省肿瘤医院胸外科,成都610041 [7]福建医科大学附属协和医院胸外科,福州350001 [8]安徽医科大学附属第一医院胸外科,合肥230022 [9]郑州大学附属肿瘤医院胸外科,郑州450008 [10]北京大学附属肿瘤医院胸外科,北京100142 [11]长海医院胸心外科,上海200433 [12]辽宁肿瘤医院胸外科,沈阳110042 [13]吉林大学附属第一医院胸外科,长春130021 [14]四川大学华西医院胸外科,成都610041 [15]复旦大学附属华山医院胸外科,上海200032 [16]天津医科大学附属肿瘤医院食管癌中心,天津300060 [17]浙江省肿瘤医院胸外科,杭州310022 [18]江西省人民医院胸外科,南昌330006 [19]不详

出　　处：《中国肺癌杂志》2016年第7期453-458,共6页Chinese Journal of Lung Cancer

摘　　要：背景与目的胸腔镜胸腺切除术相比开放手术治疗早期(Masaoka-Koga Ⅰ期或Ⅱ期)胸腺恶性肿瘤在理论上具有优势,然而尚未有研究报道其在长期生存率方面的差异。本研究基于中国胸腺肿瘤研究协作组(Chinese Alliance for Research in Thymomas,ChART)的数据库对此进行了研究。方法以数据库中1994年到2012年间的1,117例早期(Masaoka-Koga Ⅰ期或Ⅱ期)胸腺恶性肿瘤患者为研究对象。其中241例行胸腔镜胸腺切除术,876例行开放手术。采用单因素分析比较两组的临床资料与围手术期结果方面的差异。采用多因素分析明确影响长期预后的相关因素。结果与开放手术组相比,胸腔镜组的全胸腺切除比例更高(80.5%vs73.9%,P=0.028),根治性切除率更高(98.8%vs 88.7%,P<0.000),而复发率更低(2.9%vs 16.0%,P<0.001),5年无瘤生存率更高(92%vs 83%,P=0.011),而两组的5年生存率接近(92%vs 92%,P=0.15)。Cox比例风险模型分析显示WHO分型、Masaoka-Koga分期和术后辅助治疗是影响胸腺恶性肿瘤长期生存的独立因素。结论胸腔镜胸腺切除术是治疗早期胸腺恶性肿瘤安全有效的方法,与开放手术相比其围手术期效果更好,肿瘤学疗效一致。Background and objectiveVideo-assisted thoracoscopic surgery （VATS） theoretically offers advantages over open thymectomy for clinically early-stage （Masaoka-Koga stage I and II） thymic malignancies. However, longterm outcomes have not been well studied. We compared the postoperative outcomes and survival from a cohort study based on the database of the Chinese Alliance for Research in Thymomas （ChART）.MethodsBetween 1994 and 2012, data of 1,117 patients hav-ing surgery for clinically early-stage （Masaoka-Koga stage I and II） tumors were enrolled for the study. Among them, 241 cases underwent VATS thymectomy （VATS group）, while 876 cases underwent open thymectomy （Open group）. Univariate analyses were used to compare the clinical character and perioperative outcomes between the two groups. And multivariate analysis was performed to determine the independent predictive factors for long-term survival.Results Compared with the Open group, the VATS group had higher percentage of total thymectomy （80.5%vs 73.9%,P=0.028）, resection rate （98.8%vs 88.7%,P〈0.001） and less recurrence （2.9%vs 16.0%,P〈0.001）. Five-year overall survival was 92% atfer VATS and 92% atfer open thymectomy, with no signiifcant difference between the two groups （P=0.15）. However, 5-year disease free survival were 92% in VATS group and 83% in Open group （P=0.011）.Cox proportional hazards model revealed that WHO classiifcation, Masaoka-Koga stage and adjuvant therapy were independent predictive factors for overall survival, while surgical approach had no signiifcant impact on long-term outcome.ConclusionhTis study suggests that VATS thymectomy is an effective approach for clinically early-stage thymic malig-nancies. And it may offer better perioperative outcomes, as well as equal oncological survival.

关 键 词：胸腺恶性肿瘤 胸腺切除术 胸腔外科 开胸手术 VIDEO-ASSISTED hToracoscopic Surgery (VATS) 

分 类 号：R736.3[医药卫生—肿瘤]