胸腺癌患者临床病理特点和预后  

Clinicopathological features and prognosis of thymic carcinoma

作　　者：李鉴[1] 张德超[1] 汪良骏[1] 张大为[1] 张汝刚[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胸外科,北京100021

出　　处：《中华肿瘤杂志》2004年第4期223-225,共3页Chinese Journal of Oncology

摘　　要：目的　分析胸腺癌患者的临床病理特点 ,探讨影响预后的因素。方法　整理 5 4例胸腺癌患者的临床资料和生存资料 ,按Masaoka标准分期。其中根治切除 18例 (其中类癌 9例 ) ,姑息切除 17例 ,探查 10例。运用寿命表法计算累积生存率 ,采用Logrank检验和Cox多因素分析模型进行回顾性预后研究。结果　全组术后 5年生存率为 4 4 .4 %。肿瘤位于前纵隔和无钙化是其特点 ,在鉴别诊断中起重要作用。肿瘤大小、病理类型、手术方式、是否外侵和术后复发是影响预后的重要因素。类癌与其他胸腺癌相比 ,病变较早 ,切除率较高 ,预后较好。结论　肿瘤大小、病理类型、手术方式、是否外侵和术后复发是影响胸腺癌预后的主要因素 ,分期指标的选择应参照该结果。胸腺癌的治疗应首先考虑完整切除 ,并根据病理类型辅以放化疗。Objective To investigate the clinicopathologic features of thymic carcinoma and assess its prognostic factors. Methods A retrospective analysis was performed in 54 patients with thymic carcinoma who underwent surgical resection. Eighteen patients were treated by total resection of the tumor,17 partial resection and 10 exploratory thoracotomy. The clinical stage was determined according to Masaoka′s classification. The survival time and prognostic factors were evaluated by the log-rank and Cox multivariate analysis model. Results The overall 5-year survival rate was 44.4%. Being located in anterior mediastinum and noncalcification in the tumor pathognomonically played an important role in the differential diagnosis. According to the multivariate analysis,tumor maximum diameter (OR=1.84),histological subtype (OR=1.70),completeness of resection (OR= 1.37 ),tumor invasion of peritumoral organs (OR=1.32) and postoperative recurrence (OR=1.26) were significant prognostic factors. Compared with other subtypes,carcinoid tumor had the characteristics of earlier lesion,better resection rate and better prognosis. Conclusion The most important prognostic variables for thymic carcinoma are tumor maximum diameter,histological subtype,completeness of resection,tumoral invasion and postoperative recurrence. Complete resection followed by chemoradiotherapy should be considered as favorable on the basis of a definitive pathologic diagnosis.

关 键 词：胸腺癌 临床表现 病理特点 预后 肿瘤转移 

分 类 号：R736.3[医药卫生—肿瘤]