24例胸腺鳞癌的临床分析
|
摘要
目的总结胸腺鳞癌(TSCC)的临床病理特点、诊治情况并初步分析预后影响因素。方法回顾性分析北京胸科医院2006年1月至2013年4月收治疗的24例TSCC患者,其中接受手术治疗15例(10例术后联合放化疗,3例术后化疗,1例术后放疗,1例未行术后辅助治疗),9例姑息性放化疗,分析TSCC患者的临床病例资料,收集随访资料并采用KaplanMeier法进行生存分析。结果全组随访1. 0～139. 0个月,中位随访时间53. 2个月。至随访截止日期死亡15例,总生存期(OS)为2. 5～139. 0个月,中位OS为68. 1个月; 1、3、5年生存率分别为70. 8%、54. 2%和41. 7%,单因素分析显示Masaoka分期(P=0. 018)、是否手术切除(P=0. 016)及手术方式(P=0. 017)是影响患者OS的因素,术后放疗并未延长患者OS(P=0. 401)。结论 TSCC的临床表现缺乏特异性,手术是其主要治疗手段,Masaoka分期和手术等因素对患者预后有影响,根治术预后明显优于姑息性手术。术后放疗并未能使患者取得生存获益,临床应结合患者体能状态、肿瘤切除完整性等因素来制定术后治疗方案。
Objective To summarize the clinicopathological characteristics,diagnosis and therapy as well as the prognostic factors of patients with thymic squamous cell carcinoma( TSCC). Methods Twenty-four patients with TSCC admitted to Beijing Chest Hospital from January 2006 to April 2013 were retrospectively analyzed. Among them,15 cases received surgical treatment( 10 cases of combined radiotherapy and chemotherapy after operation,3 cases of chemotherapy after operation,1 case of radiotherapy after operation and 1 case without adjuvant treatment after operation) and 9 cases received palliative radiotherapy and chemotherapy. The clinical data of TSCC patients were analyzed. Follow-up data were collected and survival analysis was performed by Kaplan-Meier method. Results All patients were followed up for 1. 0 to 139. 0 months with a median follow-up time of 53. 2 months. The overall survival( OS) was2. 5-139. 0 months with a median OS of 68. 1 months. The 1-,3-and 5-year survival rates were 70. 8%,54. 2% and 41. 7%,respectively. Kaplan-Meier univariate analysis indicated that Masaoka stage( P = 0. 018),surgical resection( P = 0. 016) and surgical resection integrity( P = 0. 017) were the prognostic factors of TSCC patients. Postoperative radiotherapy did not prolong the patients' prognosis( P = 0. 401). Conclusion The clinical manifestation of TSCC is lack of specificity. Surgery is the main treatment. Masaoka stage and surgery have an impact on the prognosis of patients. Radical surgery has a better prognosis than palliative surgery. Postoperative radiotherapy has not been able to benefit patients' survival. Clinical treatment should be formulated according to the physical condition of patients and the integrity of tumor resection.
Objective To summarize the clinicopathological characteristics,diagnosis and therapy as well as the prognostic factors of patients with thymic squamous cell carcinoma( TSCC). Methods Twenty-four patients with TSCC admitted to Beijing Chest Hospital from January 2006 to April 2013 were retrospectively analyzed. Among them,15 cases received surgical treatment( 10 cases of combined radiotherapy and chemotherapy after operation,3 cases of chemotherapy after operation,1 case of radiotherapy after operation and 1 case without adjuvant treatment after operation) and 9 cases received palliative radiotherapy and chemotherapy. The clinical data of TSCC patients were analyzed. Follow-up data were collected and survival analysis was performed by Kaplan-Meier method. Results All patients were followed up for 1. 0 to 139. 0 months with a median follow-up time of 53. 2 months. The overall survival( OS) was2. 5-139. 0 months with a median OS of 68. 1 months. The 1-,3-and 5-year survival rates were 70. 8%,54. 2% and 41. 7%,respectively. Kaplan-Meier univariate analysis indicated that Masaoka stage( P = 0. 018),surgical resection( P = 0. 016) and surgical resection integrity( P = 0. 017) were the prognostic factors of TSCC patients. Postoperative radiotherapy did not prolong the patients' prognosis( P = 0. 401). Conclusion The clinical manifestation of TSCC is lack of specificity. Surgery is the main treatment. Masaoka stage and surgery have an impact on the prognosis of patients. Radical surgery has a better prognosis than palliative surgery. Postoperative radiotherapy has not been able to benefit patients' survival. Clinical treatment should be formulated according to the physical condition of patients and the integrity of tumor resection.
引文
[1] Travis WD,Brambilla E,Müller-Hermelink HK,et al. WHO classification of pathology and genetics of tumours of the lung,pleura,thymus and heart,3th edition[M]. Lyon:International Agency for Research on Cancer,2004:105-144.
[2] Travis WD,Brambilla E,Burke AP,et al. WHO Classification of tumours of the lung,pleura,thymus and heart[M]. Lyon:International Agency for Research on Cancer,2015:183-299.
[3] Fu H,Gu ZT,Fang WT,et al. Long-term survival after surgical treatment of thymic carcinoma:a retrospective analysis from the chinese alliance for research of thymoma database[J]. Ann Surg Oncol,2016,23(2):619-625.
[4]史敏科,陈宝俊,袁文杰,等. 11例胸腺鳞癌患者的临床分析[J].中华肿瘤杂志,2014,36(5):385-386.
[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(3):878-884.
[6] Hsu HC,Huang EY,Wang CJ. Postoperative radiotherapy in thymic carcinoma:treatment results and prognostic factors[J].Int J Radiat Oncol Biol Phys,2002,52(3):801-805.
[7] Ahmad U,Yao X,Detterbeck F,et al. Thymic carcinoma outcomes and prognosis:results of an international analysis[J]. J Thorac Cardiovasc Surg,2015,149(1):95-100.
[8] Zhao Y,Zhao H,Hu D,et al. Surgical treatment and prognosis of thymic squamous cell carcinoma:a retrospective analysis of105 cases[J].Ann Thorac Surg,2013,96(3):1019-1024.
[9]谷志涛,方文涛.胸腺鳞癌的综合治疗进展[J].中华胸部外科电子杂志,2017,4(4):263-265.
[10]方三高,李晟磊,陈岗. 2015年WHO肺、胸膜、胸腺及心脏肿瘤分类(胸腺)解读[J].重庆医学,2015,44(36):5041-5053.
[11]杨富,傅建华,中国胸腺肿瘤研究协作组.术后放疗在胸腺肿瘤治疗中的临床价值:中国胸腺肿瘤研究协作组回顾性研究[J].中华胸部外科电子杂志,2015,2(2):20-28.
[12] Luo Y,Li JL,Yang L,et al. Chemotherapy with gemcitabine plus cisplatin in patients with advanced thymic squamous cell carcinoma:Evaluation of efficacy and toxicity[J]. Thorac Cancer,2016,7(2):167-172.
[13] Berardi R,De Lisa M,Pagliaretta S,et al. Thymic neoplasms:an update on the use of chemotherapy and new targeted therapies.A literature review[J]. Cancer Treat Rev,2014,40(4):495-506.
[14] Cho J,Kim HS,Ku BM,et al. Pembrolizumab for patients with refractory or relapsed thymic epithelial tumor:an open-label phaseⅡtrial[J/OL]. J Clin Oncol, 2018[2018-11-15].https://www.ncbi.nlm.nih.gov/pubmed/29906252.
[2] Travis WD,Brambilla E,Burke AP,et al. WHO Classification of tumours of the lung,pleura,thymus and heart[M]. Lyon:International Agency for Research on Cancer,2015:183-299.
[3] Fu H,Gu ZT,Fang WT,et al. Long-term survival after surgical treatment of thymic carcinoma:a retrospective analysis from the chinese alliance for research of thymoma database[J]. Ann Surg Oncol,2016,23(2):619-625.
[4]史敏科,陈宝俊,袁文杰,等. 11例胸腺鳞癌患者的临床分析[J].中华肿瘤杂志,2014,36(5):385-386.
[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(3):878-884.
[6] Hsu HC,Huang EY,Wang CJ. Postoperative radiotherapy in thymic carcinoma:treatment results and prognostic factors[J].Int J Radiat Oncol Biol Phys,2002,52(3):801-805.
[7] Ahmad U,Yao X,Detterbeck F,et al. Thymic carcinoma outcomes and prognosis:results of an international analysis[J]. J Thorac Cardiovasc Surg,2015,149(1):95-100.
[8] Zhao Y,Zhao H,Hu D,et al. Surgical treatment and prognosis of thymic squamous cell carcinoma:a retrospective analysis of105 cases[J].Ann Thorac Surg,2013,96(3):1019-1024.
[9]谷志涛,方文涛.胸腺鳞癌的综合治疗进展[J].中华胸部外科电子杂志,2017,4(4):263-265.
[10]方三高,李晟磊,陈岗. 2015年WHO肺、胸膜、胸腺及心脏肿瘤分类(胸腺)解读[J].重庆医学,2015,44(36):5041-5053.
[11]杨富,傅建华,中国胸腺肿瘤研究协作组.术后放疗在胸腺肿瘤治疗中的临床价值:中国胸腺肿瘤研究协作组回顾性研究[J].中华胸部外科电子杂志,2015,2(2):20-28.
[12] Luo Y,Li JL,Yang L,et al. Chemotherapy with gemcitabine plus cisplatin in patients with advanced thymic squamous cell carcinoma:Evaluation of efficacy and toxicity[J]. Thorac Cancer,2016,7(2):167-172.
[13] Berardi R,De Lisa M,Pagliaretta S,et al. Thymic neoplasms:an update on the use of chemotherapy and new targeted therapies.A literature review[J]. Cancer Treat Rev,2014,40(4):495-506.
[14] Cho J,Kim HS,Ku BM,et al. Pembrolizumab for patients with refractory or relapsed thymic epithelial tumor:an open-label phaseⅡtrial[J/OL]. J Clin Oncol, 2018[2018-11-15].https://www.ncbi.nlm.nih.gov/pubmed/29906252.