CAJ | 학술논문

目的提出胸腺上皮肿瘤（TET）分级标准,并探讨该分级与WHO组织学分型、临床分期的相关性及其临床病理学意义。方法对200例TET采用WHO病理分型和Masaoka临床分期，结合临床治疗和随访资料进行了系统的相关性研究并进行了TET分级。结果胸腺瘤A型8例（4. 0%），AB型68例（34.0%），B1型17例（8.5%），B2型39例（19.5%），B3型27例（13.5 %），C型36例（18.0%），其他5例（2.5%）。组织学分型与预后的相关性有非常显著性意义（ P＜0.001)，A和AB型预后好，无一例患者死于肿瘤，B2、B3和C型较差。临床Ⅰ期：96例（48.0%），Ⅱ期：26例（13.0%），Ⅲ期：65例（32.5%），Ⅳ期13例（6.5% ）。临床分期与预后的相关性亦有非常显著性意义(P＜0.001），Ⅲ期和Ⅳ期预后较差。组织学分型与临床分期的相关性同样有非常显著性意义（P＜0.001），组织学分型提示在Ⅰ期、Ⅱ期TET中，B2、B3和C型的预后明显较其他类型差（P＜0.001）。根据TET的组织学、临床资料、生物学行为和预后情况提出了TET分级的建议：胸腺瘤Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级，统计学分析表明TET分级与患者的治疗和预后的相关性有非常显著性意义（P＜0.001），Ⅰ级和Ⅱ级TET在根治术后仅需密切随访，一般不需过度治疗。本组病例中伴重症肌无力30例（15 . 0%），最多见于B2和B3型胸腺瘤。结论 TET的WHO组织学分型可以作为独立的预后指标；T ET的分级有助于病理和临床的统一，可提示临床医师采取合适的治疗策略和正确判断预后。
목적제출흉선상피종류（TET）분급표준,병탐토해분급여WHO조직학분형、림상분기적상관성급기림상병이학의의。방법대200례TET채용WHO병리분형화Masaoka림상분기，결합림상치료화수방자료진행료계통적상관성연구병진행료TET분급。결과흉선류A형8례（4. 0%），AB형68례（34.0%），B1형17례（8.5%），B2형39례（19.5%），B3형27례（13.5 %），C형36례（18.0%），기타5례（2.5%）。조직학분형여예후적상관성유비상현저성의의（ P＜0.001)，A화AB형예후호，무일례환자사우종류，B2、B3화C형교차。림상Ⅰ기：96례（48.0%），Ⅱ기：26례（13.0%），Ⅲ기：65례（32.5%），Ⅳ기13례（6.5% ）。림상분기여예후적상관성역유비상현저성의의(P＜0.001），Ⅲ기화Ⅳ기예후교차。조직학분형여림상분기적상관성동양유비상현저성의의（P＜0.001），조직학분형제시재Ⅰ기、Ⅱ기TET중，B2、B3화C형적예후명현교기타류형차（P＜0.001）。근거TET적조직학、림상자료、생물학행위화예후정황제출료TET분급적건의：흉선류Ⅰ급、Ⅱ급、Ⅲ급화Ⅳ급，통계학분석표명TET분급여환자적치료화예후적상관성유비상현저성의의（P＜0.001），Ⅰ급화Ⅱ급TET재근치술후부수밀절수방，일반불수과도치료。본조병례중반중증기무력30례（15 . 0%），최다견우B2화B3형흉선류。결론 TET적WHO조직학분형가이작위독립적예후지표；T ET적분급유조우병리화림상적통일，가제시림상의사채취합괄적치료책략화정학판단예후。
Objective　 To study the clinicopathologic relevance of a thymic epithe lial tumor (TET) grading standard with the WHO classification. Methods　 A gradi ng system for TET was proposed based on the application of WHO histological typi ng of thymic tumors and analyzed in relation to clinical therapy results and fol low-up data of 200 TET cases. Results　 In this series, 8 patients (4.0%) belong ed to type A, 68 (34.0%) were type AB, 17 (8.5%) were type B1, 39 (19.5%) were t ype B2, 27 (13.5%) were type B3 and 36 (18.0%) were type C. The remaining 5 case s were rare thymomas. The overall postoperative survival data showed highly sign ificant differences among the histological subtypes (P<0.001). Typ e A & type AB thymomas showed excellent prognosis, none of these patients died of tu mor; in type B1, only 1 case (5.9%) died at 22 months postoperatively. Types B2, B3 and C thymomas shared the bad, worse and worst prognosis. Ninety-six patien t s (48.0%) were in stage I, 26 (13.0%) in stage II, 65 (32.5%) in stage III and 1 3 (6.5%) in stage IV. Clinical stage is also highly significant in predicting su rvival (P<0.001). It was found that tumor histology could predict surv ival expectancies well in stage I and stage II cases. It was also found that typ e B2, B3 and C thymomas had a statistically significant worse prognosis than typ e A, AB and B1 thymomas (P<0.001). According to the histology, cli nica l data, biological behavior and prognosis, it is proposed that thymomas be divid ed into 4 grades: grade I, II, III and IV. Follow-up is the best strategy for g r ade I & II patients after radical surgery. In this series, the 30 patients (15.0 %) presenting clinical signs of myasthenia gravis were mostly in type B2 and B3 groups (P<0.01). Conclusions　 The WHO classification for TET provides good patho logical definitions and criteria for diagnosis, which can independently predict the invasiveness and prognosis of TET. TET grading is of use in unifying patholo gical and clinical findings, in selection of proper therapy and in predicting pr ognosis.