CAJ | 학술논문

目的观察侵袭性胸腺瘤的手术治疗效果,并分析影响患者预后的相关因素.方法回顾性分析2000年1月至2009年12月接受手术治疗的59例侵袭性胸腺瘤患者的临床及随访资料.患者为连续病例,男性34例,女性25例;年龄18～72岁,平均49岁.根治性手术44例,姑息切除或活检15例.Masaoka分期:Ⅱ期18例,Ⅲ期30例,Ⅳ期11例;Ⅱ期患者术后未接受辅助放疗或化疗,Ⅲ、Ⅳ期患者术后接受辅助放疗和(或)化疗26例,未接受辅助放疗或化疗15例.分析手术方式、Masaoka分期、辅助放疗和(或)化疗与患者预后的关系.结果本组59例患者随访时间1～111个月,平均54个月;失访3例,失访率6.1%.全组局部复发或全身转移19例,死亡14例,3年、5年生存率分别为86.8%、70.8%.单因素分析显示接受完全性切除手术、Masaoka分期较早及术后接受辅助放疗和(或)化疗的患者有较高的生存率(P＜0.05).多因素分析显示是否完全性切除、术后接受辅助放疗和(或)化疗是影响患者预后的独立因素(P＜0.05).结论 Masaoka分期与侵袭性胸腺瘤患者预后相关;完全性切除手术及术后辅助放化疗可显著提高患者生存率;部分复发患者再次手术后亦可获得长期生存.
목적 관찰침습성흉선류적수술치료효과,병분석영향환자예후적상관인소.방법 회고성분석2000년1월지2009년12월접수수술치료적59례침습성흉선류환자적림상급수방자료.환자위련속병례,남성34례,녀성25례;년령18～72세,평균49세.근치성수술44례,고식절제혹활검15례.Masaoka분기:Ⅱ기18례,Ⅲ기30례,Ⅳ기11례;Ⅱ기환자술후미접수보조방료혹화료,Ⅲ、Ⅳ기환자술후접수보조방료화(혹)화료26례,미접수보조방료혹화료15례.분석수술방식、Masaoka분기、보조방료화(혹)화료여환자예후적관계.결과 본조59례환자수방시간1～111개월,평균54개월;실방3례,실방솔6.1%.전조국부복발혹전신전이19례,사망14례,3년、5년생존솔분별위86.8%、70.8%.단인소분석현시접수완전성절제수술、Masaoka분기교조급술후접수보조방료화(혹)화료적환자유교고적생존솔(P＜0.05).다인소분석현시시부완전성절제、술후접수보조방료화(혹)화료시영향환자예후적독립인소(P＜0.05).결론 Masaoka분기여침습성흉선류환자예후상관;완전성절제수술급술후보조방화료가현저제고환자생존솔;부분복발환자재차수술후역가획득장기생존.
Objectives To observe the clinical outcome of invasive thymoma, and analyze how the surgical methods, Masaoka staging, adjuvant radiotherapy and/or chemotherapy affect the prognosis. Methods The clinical data of 59 surgical patients with invasive thymoma and conducted follow-up from January 2000 to December 2009 was analyzed retrospectively. There were 34 male and 25 female, aged from 18 to 72 years with a mean age of 49 years. Forty-four cases underwent radical resection while the other 15cases underwent palliative resection or biopsy. Masaoka staging: 18 cases with stage Ⅱ , 30 cases with stage Ⅲ, 11 cases with stage Ⅳ. Patients with stage Ⅱ didn't undergo further adjuvant radiotherapy or chemotherapy after surgery. Among the patients with stage Ⅲ and stage Ⅳ, 26 patients received adjuvant radiotherapy and/or chemotherapy after surgery, while the other 15 patients did not receive any further therapy. The relationship between the prognosis and the different surgical methods, Masaoka staging, adjuvant radiotherapy and or chemotherapy was evaluated. Results Fifty-nine patients had been followed up for 1 to 111 months with an average of 54 months. Three cases were lost with the rate of 6.1%. Nineteen patients suffered local recurrence or systemic metastasis, and 14 of them died. The 3-year and 5-year survival rates were 86.8% and 70.8% respectively. Univariate analysis indicated that patients with early Masaoka staging and who received radical resection, adjuvant radiotherapy and/or chemotherapy after surgery had better survival (P<0.05). Multivariate analysis indicated that radical resection, adjuvent radiotherapy and or chemotherapy were the most significant prognostic factors which could remarkably improve the survival of patients (P<0.05). For patients with resectable recurrence, reoperation could also improve survival.Conclusions The Masaoka staging is related to the prognosis of patients with invasive thymoma. Radical resection, adjuvant radiotherapy, chemotherapy can significantly improve the survival of patients with invasive thymoma. Reoperation can improve the survival of some patients with recurrence.