胸腺切除范围对早期胸腺上皮肿瘤预后的影响  

Thymectomy versus Tumor Resection for Early-stage Thymic Malignancies:A Chinese Alliance for Research in Thymomas(ChART) Retrospective Database Analysis

作　　者：谷志涛[1] 傅剑华[2] 沈毅[3] 魏煜程 谭黎杰[4] 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[1] 方文涛[1] 中国胸腺肿瘤协作组成员 

机构地区：[1]上海交通大学附属上海胸科医院,上海200030 [2]中山大学附属肿瘤医院胸外科,广州510060 [3]青岛大学医学院附属医院胸外科,266001 [4]复旦大学附属中山医院胸外科,上海200032 [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459-464,共6页Chinese Journal of Lung Cancer

摘　　要：背景与目的探采用中国胸腺肿瘤协作组胸腺肿瘤多中心回顾性数据库,探讨胸腺切除范围对早期胸腺上皮肿瘤预后的影响。方法选择Masaoka-Koga分期Ⅰ期、Ⅱ期且术前没有接受新辅助治疗的患者,根据术中胸腺切除程度,分为胸腺切除组及胸腺瘤切除组。对比分析两组患者的临床特点及预后差异。结果共有1,047例患者纳入研究,其中胸腺切除组入组796例患者、胸腺瘤切除组入组251例患者。对于术前合并重症肌无力(myasthenia gravis,MG)的患者,胸腺切除组术后的MG的缓解率明显优于胸腺瘤切除组(91.6%vs 50.0%,P<0.001)。胸腺切除组的10年总体生存率(overall survival,OS)为90.9%,胸腺瘤切除组的10年OS为89.4%,两者之间没有统计学差异(P=0.732)。胸腺切除组术后复发率为3.7%,胸腺瘤切除组术后复发率为6.2%,两组之间无统计学差异(P=0.149)。进一步分层分析显示,对于Masaoka-Koga Ⅰ期患者,胸腺切除组和胸腺瘤切除组在复发率上没有差异(3.2%vs 1.4%,P=0.259);然而在Masaoka-Koga Ⅱ期患者中,胸腺切除组的复发率明显低于胸腺瘤切除组的复发率(2.9%vs 14.5%,P=0.001)。结论胸腺切除是治疗胸腺上皮肿瘤的标准手术方式,特别是对于Masaoka-Koga Ⅱ期及合并MG的患者。Background and objectiveTo evaluate the surgical outcomes of tumor resection with or without total thymectomy for thymic epithelial tumors （TETs） using the Chinese Alliance for Research in Thymomas （ChART） retrospec-tive database.Methods Patients without preoperative therapy, who underwent surgery for early-stage （Masaoka-Koga stage I and II） tumors, were enrolled for the study. They were divided into thymectomy and thymomectomy groups according to the resection extent of the thymus. Demographic and surgical outcomes were compared between the two patients groups. Results A total of 1,047 patients were enrolled, with 796 cases in the thymectomy group and 251 cases in the thymomec-tomy group. Improvement rate of myasthenia gravis （MG） was higher atfer thymectomy than atfer thymomectomy （91.6%vs 50.0%,P〈0.001）. Ten-year overall survival was similar between the two groups （90.9% atfer thymectomy and 89.4% atfer thymomectomy,P=0.732）. Overall, recurrence rate was 3.1% atfer thymectomy and 5.4% atfer thymomectomy, with no sig-niifcant difference between the two groups （P=0.149）. Stratiifed analysis revealed no signiifcant difference in recurrence rates in Masaoka-Koga stage I tumors （3.2%vs 1.4%,P=0.259）. However in patients with Masaoka-Koga stage II tumors, recurrence was signiifcantly less atfer thymectomy group than atfer thymomectomy （2.9%vs 14.5%,P=0.001）.Conclusion hTymectomy, instead of tumor resection alone, should still be recommended as the surgical standard for thymic malignancies, especially for stage II tumors and those with concomitant MG.

关 键 词：胸腺上皮肿瘤 重症肌无力 胸腺切除 胸腺瘤切除 

分 类 号：R736.3[医药卫生—肿瘤]