术后放疗对Ⅱ期胸腺瘤患者的影响
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摘要
目的探讨术后放疗对Ⅱ期胸腺瘤患者的影响。方法回顾性分析2008年1月-2015年10月经术后病理证实的78例MasaokaⅡ期胸腺瘤患者的临床病理资料,应用Kaplan-Meier法计算生存率并绘制生存曲线,χ~2检验或Fisher精确检验进行复发风险因素分析。结果全组患者总生存率为88.5%,3年生存率为94.9%,5年生存率为89.7%。完整切除与完整切除+术后放疗患者的总生存率分别为86.3%和92.6%,差异无统计学意义;3年生存率分别为94.1%和96.3%,差异无统计学意义;5年生存率分别为88.2%和92.6%,差异无统计学意义;完整切除患者复发率为21.6%,完整切除联合术后放疗患者的复发率为3.7%,差异有统计学意义。男性与女性患者的复发率分别为16.3%和14.3%,差异无统计学意义。年龄在21~30岁、31~40岁、41~50岁、51~60岁和>60岁患者复发率分别为15.4%、18.8%、15.4%、14.3%和11.1%,差异无统计学意义。肿瘤最大直径≤3 cm、3~5cm、5~7cm和﹥7cm患者复发率分别为5.3%、15.2%、23.5%和22.2%,差异无统计学意义。世界卫生组织(WHO)分型中A型、AB型、B1型、B2型、B3型患者的复发率分别为0.0%、0.0%、7.1%、19.4%和35.7%,差异有统计学意义。合并重症肌无力(MG)与未合并MG患者的复发率分别为11.8%和29.6%,差异有统计学意义。结论 MasaokaⅡ期胸腺瘤患者完整手术切除后辅以放疗并不能提高生存率,但可以降低复发率;WHO分型、是否合并MG是影响Ⅱ期胸腺瘤复发的风险因素。
Objective To investigate the role of adjuvant radiotherapy for stage Ⅱ thymoma after complete tumor resection. Methods The clinicopathological data of 78 patients with Masaoka stage Ⅱ thymoma confirmed by cytological examination of hydrothorax from January 2008 to October 2015 were retrospectively analyzed. The Kaplan-Meier method was used to calculate the survival rate and the survival curve was drawn.χ~2 test or Fisher's exact probability test was used to analyze the recurrent risk factors. Results The overall survival rate was 88.5%, the overall 3-year survival rate was 94.9% and the 5-year survival rate was 89.7%.The overall survival rate, 3-year survival rate and 5-year survival rate in the complete resection patients and the patients receiving adjuvant radiotherapy after complete resection were 86.3% and 92.6%, 94.1% and96.3%, 88.2% and 92.6% respectively(P > 0.05). The recurrent rates in the complete resection patients and the patients having adjuvant radiotherapy after complete resection were 21.6% and 3.7% respectively with significant difference. The recurrent rates for the male and female patients were 16.3% and 14.3% respectively without significant difference. In the patients with the age of 21-30, 31-40, 41-50, 51-60 and >60 years,the recurrent rates were 15.4%, 18.8%, 15.4%, 14.3% and 11.1% respectively; there were no significant differences. In the patients with the max tumor diameter ≤3 cm, 3-5 cm, 5-7 cm and >7 cm, the recurrent rates were 5.3%, 15.2%, 23.5% and 22.2% respectively; there were no significant differences. The recurrent rates were 0.0%, 0.0%, 7.1%, 19.4% and 35.7% in the patients with WHO type A, AB, B1, B2 and B3 respectively without significant differences. In the patients with myasthenia gravis(MG) and without MG, the recurrent rates were 11.8% and 29.6% respectively, there was significant difference. Conclusions Adjuvant radiotherapy for stage Ⅱ thymoma after complete tumor resection may not improve overall survival rate but may reduce recurrent rate. WHO type and MG are the recurrent risk factors for stage Ⅱ thymomas.
Objective To investigate the role of adjuvant radiotherapy for stage Ⅱ thymoma after complete tumor resection. Methods The clinicopathological data of 78 patients with Masaoka stage Ⅱ thymoma confirmed by cytological examination of hydrothorax from January 2008 to October 2015 were retrospectively analyzed. The Kaplan-Meier method was used to calculate the survival rate and the survival curve was drawn.χ~2 test or Fisher's exact probability test was used to analyze the recurrent risk factors. Results The overall survival rate was 88.5%, the overall 3-year survival rate was 94.9% and the 5-year survival rate was 89.7%.The overall survival rate, 3-year survival rate and 5-year survival rate in the complete resection patients and the patients receiving adjuvant radiotherapy after complete resection were 86.3% and 92.6%, 94.1% and96.3%, 88.2% and 92.6% respectively(P > 0.05). The recurrent rates in the complete resection patients and the patients having adjuvant radiotherapy after complete resection were 21.6% and 3.7% respectively with significant difference. The recurrent rates for the male and female patients were 16.3% and 14.3% respectively without significant difference. In the patients with the age of 21-30, 31-40, 41-50, 51-60 and >60 years,the recurrent rates were 15.4%, 18.8%, 15.4%, 14.3% and 11.1% respectively; there were no significant differences. In the patients with the max tumor diameter ≤3 cm, 3-5 cm, 5-7 cm and >7 cm, the recurrent rates were 5.3%, 15.2%, 23.5% and 22.2% respectively; there were no significant differences. The recurrent rates were 0.0%, 0.0%, 7.1%, 19.4% and 35.7% in the patients with WHO type A, AB, B1, B2 and B3 respectively without significant differences. In the patients with myasthenia gravis(MG) and without MG, the recurrent rates were 11.8% and 29.6% respectively, there was significant difference. Conclusions Adjuvant radiotherapy for stage Ⅱ thymoma after complete tumor resection may not improve overall survival rate but may reduce recurrent rate. WHO type and MG are the recurrent risk factors for stage Ⅱ thymomas.
引文
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[8]RUFFINI E,MANCUSO M,OLIARO A,et al.Recurrence of thymoma:analysis of clinicopathologic features,treatment,and outcome[J].J Thorac Cardiovasc Surg,1997,113(21):55-63.
[9]QUINTANILLA-MARTINEZ L,WILKINS E W J R,CHOI N,et al.Thymoma:histologic subclassification is an independent prognostic factor[J].Cancer,1994,74(21):606-617.
[10]FERNANDES A T,SHINOHARA E T,GUO M,et al.The role of radiation therapy in malignant thymoma:a surveillance,Epidemiology and end results database analysis[J].J Thorac Oncol,2010,5(9):1454-1460.
[11]AYDINER A,TOKER A,SEN F,et al.Association of clinical and pathological variables with survival in thymoma[J].Med Oncol,2012,29(12):2221-2228.
[12]VENUTA F,RENDINA E A,ANILE M,et al.Thymoma and thymic carcinoma[J].Gen Thorac Cardiovasc Surg,2012,60(10):1-12.
[13]AYDINER A,TOKER A,SEN F,et al.Association of clinical and pathological variables with survival in thymoma[J].Med Oncol,2012,29(11):2221-2228.
[2]NARENDRA K,RITESH K,ANJAN B,et al.Thymoma:clinical experience from a tertiary care institute from North India[J].Journal of Cancer Research and Therapeutics,2013,9(6):235-239.
[3]TRAVIS W,BRAMBILLA W,MULLER-HERMELINK H,et al.World Health Organizaion classification of tumors.Pathology and genetics of tumors of the lung,pleura,thymus and heart[M].Lyon:IARC Press,2004.
[4]SINGH G,RUMENDE C M,AMIN Z.Thymoma:Diagnosis and Treatment[J].Acta Med Indones,2011,43(17):74-78.
[5]KONDO K,MONDEN Y.Therapy for Thymic epithelial tumors:a clinical study of 1,320 patients from Japan[J].Ann Thorac Surg,2003,76(12):878-885.
[6]SINGHAL S,SHRAGER J B,ROSENTHAL D I,et al.Comparison of stages I~Ⅱthymoma trested by complete resection with or without adjuvant radiation[J].Ann Thorac Surg,2003,76(1):1635-1641.
[7]MANGI A A,WRIGHT C D,ALLAN J S,et al.Adjuvant radiation therapy for stageⅡthymoma[J].Ann Thorac Surg,2002,74(4):1033-1037.
[8]RUFFINI E,MANCUSO M,OLIARO A,et al.Recurrence of thymoma:analysis of clinicopathologic features,treatment,and outcome[J].J Thorac Cardiovasc Surg,1997,113(21):55-63.
[9]QUINTANILLA-MARTINEZ L,WILKINS E W J R,CHOI N,et al.Thymoma:histologic subclassification is an independent prognostic factor[J].Cancer,1994,74(21):606-617.
[10]FERNANDES A T,SHINOHARA E T,GUO M,et al.The role of radiation therapy in malignant thymoma:a surveillance,Epidemiology and end results database analysis[J].J Thorac Oncol,2010,5(9):1454-1460.
[11]AYDINER A,TOKER A,SEN F,et al.Association of clinical and pathological variables with survival in thymoma[J].Med Oncol,2012,29(12):2221-2228.
[12]VENUTA F,RENDINA E A,ANILE M,et al.Thymoma and thymic carcinoma[J].Gen Thorac Cardiovasc Surg,2012,60(10):1-12.
[13]AYDINER A,TOKER A,SEN F,et al.Association of clinical and pathological variables with survival in thymoma[J].Med Oncol,2012,29(11):2221-2228.