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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2018, Vol. 05 ›› Issue (02) : 107 -112. doi: 10.3877/cma.j.issn.2095-8773.2018.02.08

所属专题： 文献；

论著

胸腺瘤的外科治疗和预后分析
朱晓磊1, 朱自江2,†(), 庞瑶2, 王文昊2, 脱广鑫2   
  1. 1. 730000　兰州，甘肃中医药大学临床医学院；甘肃省人民医院胸外科
    2. 甘肃省人民医院胸外科
  • 收稿日期:2017-12-15 出版日期:2018-05-28
  • 通信作者: 朱自江

Surgical treatment and prognostic analysis of thymoma

Xiaolei Zhu1, Zijiang Zhu2,†(), Yao Pang2, Wenhao Wang2, Guangxin Tuo2   

  1. 1. School of Clinical Medicine, Gansu University of Chinese Medicine; Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou 730000, China
    2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou 730000, China
  • Received:2017-12-15 Published:2018-05-28
  • Corresponding author: Zijiang Zhu
  • About author:
    Corresponding author: Zhu Zijiang, Email:
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引用本文：

朱晓磊, 朱自江, 庞瑶, 王文昊, 脱广鑫. 胸腺瘤的外科治疗和预后分析[J]. 中华胸部外科电子杂志, 2018, 05(02): 107-112.

Xiaolei Zhu, Zijiang Zhu, Yao Pang, Wenhao Wang, Guangxin Tuo. Surgical treatment and prognostic analysis of thymoma[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(02): 107-112.

目的

探讨外科治疗在胸腺瘤治疗中的作用及预后的影响因素。

方法

回顾性分析2004年1月—2017年1月就诊于甘肃省人民医院胸外科并接受手术治疗的55例胸腺瘤患者的临床资料。生存率的计算及单因素生存分析采用Kaplan-Meier法进行，组间差异使用Log-rank检验进行计算，所有经单因素生存分析有意义的参数均纳入多因素生存，采用Cox分析确定与预后相关的因素。

结果

55例胸腺瘤患者中，成功随访53例，失访2例。53例患者均接受手术治疗，中位随访时间75.3个月，1、3、5、10年生存率分别为71.1%、56.7%、39.3%和23.3%。单因素分析结果显示：临床症状、肿瘤直径、肿瘤切除范围、Masaoka分期、WHO组织学分类及放化疗对胸腺瘤患者术后长期生存率均有显著影响(P<0.01)；多因素Cox分析表明肿瘤切除方式(HR＝5.15，95% CI：1.573～16.883，P<0.05)、肿瘤直径(HR＝5.53，95% CI：1.879～11.797，P<0.05)、WHO分型(HR＝13.23，95% CI：3.015～29.230，P<0.05)、Masaoka分期(HR＝5.18，95%CI：1.597～13.737，P<0.05)以及放化疗(HR＝12.14，95% CI：2.979～49.503，P<0.05)是影响胸腺瘤术后生存率的独立因素。

结论

肿瘤直径、肿瘤切除方式、WHO分型、Masaoka分期以及术后放化疗是影响胸腺瘤患者预后的独立因素。

关键词: 胸腺瘤, 肿瘤直径, 肿瘤切除方式, WHO分型, Masaoka分期, 放疗, 化疗
Objective

To explore the prognostic factors affecting the long-term survival of patients with thymoma.

Methods

The clinical data of 55 patients with thymoma who were treated with thoracic surgery in Gansu Provincial People's Hospital from January 2004 to January 2017 were retrospectively analyzed. The possible prognostic factors were analyzed by univariate analysis and multivariate analysis with Kaplan-Meier method and Cox proportional hazard model, respectively.

Results

Two cases were lost and 53 cases were followed up successfully. All 53 patients underwent surgery. All patients were followed up for 1 to 125 months, and the 1, 3, 5, 10 year survival rates were 71.1%, 56.7%, 39.3% and 23.3% respectively. The significant prognostic factors demonstrated by univariate analysis included age, clinical symptoms, tumor diameter, Masaoka staging, WHO histologic classification, completeness of resection, and chemoradiotherapy (P<0.01). According to multivariate analysis, the tumor type (HR=5.15, 95% CI: 1.573-16.883, P<0.05), tumor diameter (HR=5.53, 95% CI: 1.879-11.797, P<0.05), WHO classification (HR=13.23, 95% CI: 3.015-29.230, P<0.05), Masaoka staging (HR=5.18, 95% CI: 1.597-13.737, P<0.05) and chemoradiotherapy (HR=12.14, 95% CI: 2.979-49.503, P<0.05) are independent factors affecting the postoperative survival rate of thymoma.

Conclusions

Tumor diameter, tumor resection, WHO classification, Masaoka and postoperative chemoradiotherapy were independent prognostic factors.

Key words: Thymoma, Tumor diameter, Tumor resection, WHO classification, Masaoka staging, Radiotherapy, Chemotherapy
图1 53例胸腺瘤患者术后预后单因素分析。A.有无临床症状；B.肿瘤直径；C.切除方式；D.WHO分型；E. Masaoka分期；F.术后放化疗
表1 影响恶性胸腺瘤患者预后的单因素分析
性别 1年生存率(%) 3年生存率(%) 5年生存率(%) 10年生存率(%) χ2值 P值
性别 ? ? ? ? 0.02 0.991
? 男性(n＝33) 96.8 87.8 75.8 45.8 ? ?
? 女性(n＝20) 97.6 85.7 76.2 47.6 ? ?
年龄 ? ? ? ? 5.04 0.543
? <30岁(n＝7) 85.7 71.4 61.4 42.9 ? ?
? 30～60岁(n＝36) 97.2 88.9 67.7 44.4 ? ?
? >60岁(n＝10) 89.0 79.9 70.0 40.0 ? ?
有无症状 ? ? ? ? 13.23 0.004
? 有(n＝33) 96.9 78.7 42.4 18.1 ? ?
? 无(n＝20) 100.0 95.0 90.0 78.0 ? ?
肿瘤直径 ? ? ? ? 7.748 0.021
? <5 cm(n＝13) 92.3 92.3 76.9 4.1 ? ?
? 5～10 cm(n＝27) 96.2 85.1 74.0 40.7 ? ?
? >10 cm 92.3 76.9 15.3 7.6 ? ?
肿瘤切除范围 ? ? ? ? 15.75 0.015
? R0(n＝23) 100.0 95.6 91.3 78.2 ? ?
? R1(n＝16) 87.5 75.0 43.7 7.1 ? ?
? R2(n＝14) 71.4 50 28.5 7.1 ? ?
WHO分型 ? ? ? ? 25.69 0.041
? A型(n＝11) 100.0 100.0 90.1 72.7 ? ?
? AB型(n＝13) 100.0 92.3 76.9 61.5 ? ?
? B1型(n＝6) 100.0 83.3 50.0 16.6 ? ?
? B2型(n＝9) 100.0 88.8 55.5 11，.1 ? ?
? B3型(n＝5) 80.0 75.0 40.0 0.00 ? ?
? C型(n＝9) 78.5 55.5 22.2 0.00 ? ?
Masaoka分期 ? ? ? ? 16.18 <0.001
? Ⅰ期(n＝9) 100.0 100.0 88.9 66.7 ? ?
? Ⅱ期(n＝20) 95.0 95.0 85.0 55.0 ? ?
? Ⅲ期(n＝16) 93.7 87.5 43.7 6.2 ? ?
? Ⅳ期(n＝8) 75.0 25.0 0.00 0.00 ? ?
术后放化疗 ? ? ? ? 31.81 0.001
? 是(n＝30) 93.3 78.5 40.0 20.0 ? ?
? 否(n＝23) 95.6 91.3 82.6 47.8 ? ?
表2 影响恶性胸腺瘤患者预后的多因素分析
因素 β值 Wald值 HR 95%CI P值
切除方式 1.639 7.260 5.153 (1.57～16.88) 0.007
有无症状 1.361 3.123 1.263 (0.71～3.51) 0.254
肿瘤直径 1.793 8.603 5.532 (1.87～11.79) 0.003
WHO组织学分类 2.975 14.253 13.234 (3.01～29.23) <0.001
Masaoka分期 1.645 10.852 5.185 (1.95～13.73) <0.001
放化疗 2.496 12.005 12.144 (2.97～49.50) 0.005
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