中国肿瘤临床
中國腫瘤臨床
중국종류림상
CHINESE JOURNAL OF CLINICAL ONCOLOGY
2014年
7期
456-460
,共5页
付浩%陈克能%梁震%熊宏超%康晓征%戴亮%闫万璞%杨永波%杨合利%秦斌
付浩%陳剋能%樑震%熊宏超%康曉徵%戴亮%閆萬璞%楊永波%楊閤利%秦斌
부호%진극능%량진%웅굉초%강효정%대량%염만박%양영파%양합리%진빈
原发性纵隔肿瘤%胸腺上皮肿瘤%手术%生存
原髮性縱隔腫瘤%胸腺上皮腫瘤%手術%生存
원발성종격종류%흉선상피종류%수술%생존
Primary mediastinal tumor%thymic epithelial tumour%surgery%survival
目的：总结单一医生组原发性纵隔肿瘤外科治疗的长期随访。方法：数据来自北京大学肿瘤医院2000年1月至2014年1月的前瞻性数据库。分析纵隔肿瘤数据库中以根治切除为目的患者的远期生存。结果：本组常见肿瘤依次为胸腺上皮肿瘤95例（50%），神经源性肿瘤26例（13.7%），纵隔生殖细胞肿瘤26例（13.7%）。全组患者行R0切除者179例（94.2%），R2切除者8例（4.2%），单纯探查者3例（1.6%），术后30d内死亡2例。胸腺上皮肿瘤1、3和5年生存率分别为95%、92.7%和85.7%。根据Masaoka-Koga分期，Ⅰ、Ⅱ、Ⅲ和Ⅳ期胸腺上皮肿瘤的5年生存率分别为100%、82.1%、90%和37.5%。多因素分析显示Masaoka-Koga分期是胸腺上皮肿瘤手术后独立预后因素。A+AB+B1型与B2+B3型胸腺瘤5年生存率分别为88.6%与76.9%，差异具有统计学意义（P<0.05）。神经源性纵隔肿瘤多为良性，完整切除后均长期生存。结论：纵隔肿瘤组织学复杂，根据其来源、性质、部位及大小来决定治疗。虽然本组患者生存良好，但单一医生组很难做到前瞻性，大样本研究。因此，对纵隔肿瘤尤其是胸腺上皮肿瘤亟需大样本，多中心合作的前瞻性研究，以找到合理的治疗方式。
目的：總結單一醫生組原髮性縱隔腫瘤外科治療的長期隨訪。方法：數據來自北京大學腫瘤醫院2000年1月至2014年1月的前瞻性數據庫。分析縱隔腫瘤數據庫中以根治切除為目的患者的遠期生存。結果：本組常見腫瘤依次為胸腺上皮腫瘤95例（50%），神經源性腫瘤26例（13.7%），縱隔生殖細胞腫瘤26例（13.7%）。全組患者行R0切除者179例（94.2%），R2切除者8例（4.2%），單純探查者3例（1.6%），術後30d內死亡2例。胸腺上皮腫瘤1、3和5年生存率分彆為95%、92.7%和85.7%。根據Masaoka-Koga分期，Ⅰ、Ⅱ、Ⅲ和Ⅳ期胸腺上皮腫瘤的5年生存率分彆為100%、82.1%、90%和37.5%。多因素分析顯示Masaoka-Koga分期是胸腺上皮腫瘤手術後獨立預後因素。A+AB+B1型與B2+B3型胸腺瘤5年生存率分彆為88.6%與76.9%，差異具有統計學意義（P<0.05）。神經源性縱隔腫瘤多為良性，完整切除後均長期生存。結論：縱隔腫瘤組織學複雜，根據其來源、性質、部位及大小來決定治療。雖然本組患者生存良好，但單一醫生組很難做到前瞻性，大樣本研究。因此，對縱隔腫瘤尤其是胸腺上皮腫瘤亟需大樣本，多中心閤作的前瞻性研究，以找到閤理的治療方式。
목적：총결단일의생조원발성종격종류외과치료적장기수방。방법：수거래자북경대학종류의원2000년1월지2014년1월적전첨성수거고。분석종격종류수거고중이근치절제위목적환자적원기생존。결과：본조상견종류의차위흉선상피종류95례（50%），신경원성종류26례（13.7%），종격생식세포종류26례（13.7%）。전조환자행R0절제자179례（94.2%），R2절제자8례（4.2%），단순탐사자3례（1.6%），술후30d내사망2례。흉선상피종류1、3화5년생존솔분별위95%、92.7%화85.7%。근거Masaoka-Koga분기，Ⅰ、Ⅱ、Ⅲ화Ⅳ기흉선상피종류적5년생존솔분별위100%、82.1%、90%화37.5%。다인소분석현시Masaoka-Koga분기시흉선상피종류수술후독립예후인소。A+AB+B1형여B2+B3형흉선류5년생존솔분별위88.6%여76.9%，차이구유통계학의의（P<0.05）。신경원성종격종류다위량성，완정절제후균장기생존。결론：종격종류조직학복잡，근거기래원、성질、부위급대소래결정치료。수연본조환자생존량호，단단일의생조흔난주도전첨성，대양본연구。인차，대종격종류우기시흉선상피종류극수대양본，다중심합작적전첨성연구，이조도합리적치료방식。
Objective:Mediastinal tumors are tumors derived from different organs. Due to its rarity, few clinical consensuses on its diagnosis and treatments have been concluded. This paper aims to summarize the experiences of a single-surgeon team on the surgi-cal treatment of primary medisatinal tumors. Methods:Clinical data were collected from a prospective database between January 2000 and January 2014. The analyses were mainly focused on the long-term survival of 190 cases that underwent radical resectioning surger-ies. Results:The three most common mediastinal tumors are thymic epithelial tumors in 95 cases (50%), neurogenic tumors in 26 cases (13.7%), and mediastinal germ cell tumors in 26 cases (13.7%). Of the 190 patients, 179 patients achieved the R0 resection criterion (94.2%), 8 underwent R2 resectioning (4.2%) and 3 underwent only exploration (1.6%), with 2 cases of death in the 30 days after the surgery. The 1-, 3-, and 5-year survival rates of the thymic epithelial tumor patients were 95%, 92.7%, and 85.7%, respectively. Accord-ing to the Masaoka-Koga staging, the 5-year survival rates of stageⅠ,Ⅱ,Ⅲ, andⅣthymic epithelial tumors are 100%, 82.1%, 90%, and 37.5%, respectively. A multivariate analysis reveals that the Masaoka-Koga staging of thymic epithelial tumors is an independent prognostic factor (P<0.05). According to pathological classification, the 5-year survival rates for A+AB+B1 versus B2+B3 type thymo-ma were 88.6%versus 76.9%, which is statistically significant (P<0.05). Most of the neurogenic tumors are benign, all suffer R0 resec-tioning, and have long term survival. Conclusion:Due to the complexity caused by its histology, the treatment of mediastinal tumors should be based on the origin, nature, location, and size of the tumors. Although the patients of the group have a favorable prognosis, it is difficult to draw conclusions from the studies because of its retrospective characteristics and small sample size. Therefore, to get bet-ter clinical evidence, a multi-center, large sample, and prospective clinical study should be performed.
