侵袭性胸腺瘤术后三维适形放疗预后分析  

Analysis for the prognosis of patients with invasive thymoma treated by three-dimensional conformal radiotherapy after operation

作　　者：贾佳[1,2] 朱慧军[3] 王冰[4] 李月敏[2] 

机构地区：[1]河北北方学院研究生部,河北张家口075000 [2]中国人民解放军第三O九医院放疗科,北京100091 [3]邢台市人民医院康复科,河北邢台054000 [4]北京大学第三医院泌尿外科,北京100191

出　　处：《中华肿瘤防治杂志》2016年第13期888-892,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：吴阶平医学基金(320.6750.14296);北京市首都临床特色应用研究项目(Z121107001012060)

摘　　要：目的不同临床分期及手术方式对胸腺瘤术后放疗长期生存的影响报道较少。本研究分析不同的Masaoka临床分期(Ⅱ~Ⅳ期)及手术方式(完整切除R0与不完整切除R1、R2)对胸腺瘤患者术后行三维适形放疗长期生存的影响及预后因素。方法回顾性分析中国人民解放军第三〇九医院2008-10-01-2014-05-31收治的52例侵袭性胸腺瘤术后行三维适形放疗患者临床资料,52例患者中36例接受联合化疗,其中同步放化疗14例,序贯放化疗22例。放疗采用三维适形或调强,R0切除患者计划靶区(planning target volume,PTV)剂量50Gy/25次,R1、R2切除患者PTV剂量60Gy/30次,对已明确转移者,应先给予全纵隔放疗,后局部瘤床加量。化疗采用CAP方案(顺铂60mg/m2,静脉滴入,d1;30mg/m2,静脉滴入,d2;吡柔比星70mg/m2,静脉滴入,d1;环磷酰胺800mg/m2,静脉滴入,d1,21d为1个周期)。采用Kaplan-Meier法计算生存率并以Log-rank法检验和单因素分析,独立预后因素采用Cox多因素分析进行评估。结果52例胸腺瘤患者中伴重症肌无力(myasthenia gravis,MG)的患者27例。随访时间17~83个月,中位生存时间为56个月,3年生存率为100.0%(52/52)。单因素分析结果显示,男性与女性患者的5年生存率分别为67.6%和73.3%,χ2=1.208,P=0.272;手术方式完整切除与不完整手术切除的5年生存率分别为86.1%和62.5%,χ2=4.628,P=0.031;伴或不伴重症肌无力患者的5年生存率分别为74.1%和72.0%,χ2=3.460,P=0.063;Masaoka临床分期Ⅱ、Ⅲ和Ⅳ期5年生存率分别为100.0%、81.0%和64.7%,χ2=6.986,P=0.030;WHO病理分型AB、B1、B2和B3型5年生存率分别为100.0%、87.5%、82.4%和81.8%,χ2=0.615,P=0.433。手术方式和Masaoka临床分期与预后相关。多因素分析结果显示,手术方式和Masaoka临床分期为侵袭性胸腺瘤独立预后因素。结论完整手术切除是侵袭性胸腺瘤患者术后放射治疗预后的有益因素,Ⅱ期患者生存情况较好,分期越晚预后越差�OBJECTIVE To analyze the effects of three-dimensional conformal radiotherapy on the long-term sur- vival results and prognosis in patients with invasive thymoma at different Masaoka clinical stages（Ⅱ-Ⅳ ） after operation with different operative modes（complete resection-R0 or incomplete resection-R1 , R2）. METHODS The data of 52 patients with invasive thymoma, who were admitted into No. 309 Hospital of PLA form October 1,2008 to May 31,2014 and under- went three-dimensional conformal radiotherapy after operation, were retrospectively analyzed, in whom, 36 patients received combination chemotherapy including 14 patients by synchronism chemoradiation and 22 patients by sequential chemoradiation. The radiotherapy was three-dimensional conformal mode or reinforced mode. The dosage in R0 was PTV 50 Gy/25 f, which in R1 and R2 was PTV 60 Gy/30 f. The patients who had been identified as tumor metastasis,should be treated firstly by whole mediastinum radiotherapy, then dosage was enhanced in local tumor bed. The chemotherapy a- dopted CAP scheme （cisplatin 60 mg/m2, d1, intravenous drip, 30 mg/m2, d2, intravenous drip; pirarubicin 70 mg/m2, d1, intravenous drip;cyelophosphamide 800 mg/m^2 , dl , intravenous drip,with a treatment course of 21 days）. The sur- vival rates of patients were calculated by Kaplan-Meier method and were statistically tested by Log-rank method, moreo- ver, the independent prognosis factors were evaluated by Cox multiple factor analysis. RESULTS Among 52 patients with thymoma,there were 27 patients with MG. The follow up time was 17- 83 months, median survival time was 56 months,and a-year survival rate was 100.0^（52/52）. The single factor analysis showed that the 5-year survival rate in males and females was 67.6% and 73.3%, respectively, 2 = 1. 208, P= 0. 272. The 5-year survival rate in complete re- section or incomplete resection was 86.1% and 62.5%, respectively, X2 =4. 628,P=0. 031. The 5-year survival rate in patients with or without myasthenia gravis was 74.1% and 72.0%,

关 键 词：胸腺肿瘤 术后放疗 三维适形 长期生存 预后 

分 类 号：R736.3[医药卫生—肿瘤]