174例胸腺瘤的诊治分析
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摘要
课题背景
胸腺瘤是一种胸腺上皮来源的肿瘤,它具有潜在恶性,同时常有多种合并症,最常见是胸腺瘤病人合并重症肌无力,其它可以合并多种副肿瘤综合症等。由于胸腺瘤的淋巴转移和血行转移少见,因此在TNM分期上至今仍存在着争议。胸腺瘤的治疗具有多样性,单纯良性胸腺瘤瘤依靠外科手术切除即可治愈,而侵袭性胸腺瘤的治疗方法常根据医生的意愿所决定。对胸腺瘤病人合并重症肌无力或合并其它副肿瘤综合症的病人,其治疗方案更加复杂化。本文收集我院近年七年来外科手术治疗的胸腺瘤病例174例,将收集的资料进行统计分析和总结,以探讨胸腺瘤的现状和手术疗效。
资料与方法
1.收集我院2003年1月至2010年12月经手术切除和病理证实的胸腺瘤病例共174例,分别按WHO分类法、Masaoka分期标准、MGFA重症肌无力临床分型法进行归类和统计,结果采用SPSS17.0统计学软件,计数资料相关分析通过X2检验,生存分析用Kaplan-Meier检验。
2.对174例胸腺瘤手术患者根据联系信息逐一进行了术后电话采访,部分病人进行门诊随访,其中失访43例,得到有效随访131例,分别统计单纯胸腺瘤组1年、3年、5年生存率和胸腺瘤合并重症肌无力组1年、3年、5年生存率,同时根据Masaoka分期统计各分期的5年生存率和按WHO分类法统计各组织学类型的5年生存率,并进行统计学分析。
结果
根据WHO胸腺瘤分类法,本组A型30例(18%)；AB型50例(28%)；B1型26例(15%)；B2型43例(25%)；B3型19例(11%)；C型6例(4%)。良性：恶性=46：54。按Masaoka分期标准：本组Ⅰ期69例(39%),ⅡA期33例(19%),ⅡB期22例(13%),Ⅲ期35例(19%),ⅣA期12例(8%),ⅣB期3例(2%)。本组以Ⅰ、Ⅱ期为多见。胸腺瘤合并重症肌无力61例(35%),按MGFA的临床分型评价重症肌无力的严重程度。Ⅰ型16例(26%),Ⅱ型28例(46%),Ⅲ型17例(28%),Ⅳ型0例,Ⅴ型0例。胸腺瘤合并重症肌无力本组多见于B型,其中以B2型为最多(44%)。胸腺瘤完整切除者157例,部分切除患者17例,无手术死亡病例。
术后随访统计131例资料,死亡26例,其中9例因胸腺瘤复发及重症肌无力死亡,7例因心脑血管意外死亡,3例因肺部并发症死亡,7例死因不详。按Masaoka分期,5年生存率分别为Ⅰ期100%,Ⅱ期98%,Ⅲ期82%,Ⅳ期52%,各分期比较差异有统计学意义(X2=39.87,P<0.01)。按WHO分型,5年生存率分别为A型100%,AB型95%,B1型84%,B2型81%,B3型79%,C型56%,有统计学差异(X2=0.98,P<0.05)。
结论
1.本组胸腺瘤手术患者良性与恶性比例46：54,相差不大。
2.本组胸腺瘤伴重症肌无力约占1/3(61/174),组织学类型多见于B型(79%),其中以B2型为多见(44%),临床分型则以全身型为主,病理类型与重症肌无力的严重程度无关联。
3.本组胸腺瘤治疗以手术切除为主,无手术死亡,即使是合并重症肌无力或恶性胸腺瘤,手术仍是安全的,术后疗效满意。
4.胸腺瘤预后与手术完整切除、Masaoka分期、以及WHO组织病理学分类有关。
Background:Thymoma is originated from the thymic epithelium. It is potentially malignant and can be accompanied by various complications. The most common complication was myasthenia gravis(MG) and it is often associated with some paraneoplastic syndromes. Like any tumors, adopting TNM staging system for thymoma is still controversial, because it is rarely metastasize to lymph nodes and other organs. Treatment of thymoma are various, only thymectomy is enough for benign thymomas, but for invasive thymoma, it usually depends on the surgeon's desire. Treatment options for myasthenic thymoma is more complicated. In this study, we statistically analyzed 174 thymoma patients, presented current management options and role of surgery.
Materials and Methods:
We have retrospectively analysed thymoma patients who were surgically resected and histopathologically proved as thymoma between Jan.2003 and Dec.2010. We presented thymoma patients by adopting Masaoka staging system, WHO hispopathologic classofication and MGFA classification.SPSS 17.0 was used for statistical analysis.
Results:
Thymomas were classified according to WHO hispopathologic classofication, type A thymoma (18%), type AB 50 (28%), type B1 26 (15%), type B2 43 (25%), type B3 19 (11%), and type C 6(4%), benign to malignant ratio was 46:54. Thymomas were staged by Masaoka staging system, StageⅠ69 (39%), StageⅡA 33 (19%), StageⅡB 22 (13%),Ⅲ35 (19%), StageⅣA12 (8%) and StageⅣB 3 (2%). In our series, stageⅠandⅡwere more common than other stages. Among them,61 patients were myasthenic thymoma, we grouped them by MGFA classification system into 5 groups, ClassⅠ16 (26%), ClassⅡ28 (46%), Class in 17 (28%), Class IVand ClassⅤwere 0. Type B thymoma are more associated with MG, B2 is the most common type, accounted for 44% of all mysthenic thymoma.157(90%) thymoma patients had complete resection, and 17(10%). of them had incomplete resection. There were no surgery related deaths. We conducted postoperative follow-up for 131 patients,26 were died. Among them 9 were died because of the recurrence and MG,7 were died of cardiovascular events,3 were died of pulmonary infection,7 were died of unknowed reason. Patients were followed up by Masaoka staging system, the 5-year survival rates were 100% for StageⅠ,98% for StageⅡ,82% for StageⅢ,52% for Stage IV respectively. Result of Masaoka staging system evidence was statistically significant (X2=39.87, P<0.01). Patients were followed up by WHO pathologic classification system, the 5-year survival rates were 100% for type A,95% for type AB,84% for type B1,81% for type B2,79% for type B3 and 56% for type C respectively. Result of WHO pathologic classification system evidence was statistically significant (X2=0.98, P<0.05).
Conclusion:
1. In our study, benign to malignant ratio was 46:54, no significant differences.
2. In our study, myasthenic thymoma accounts for 1/3 of all thymoma patients, major histopathological type is B2, most of them were generalized MG. There were no correlation between the severity of MG and thymoma histopathology.
3. In our study, the main treatment option was surgery, there were no surgery related death, surgery is still the mainstay treatement for mysthenic and invasive thymoma, we achieved a satisfactory result for such patients.
4. Thymoma Masaoka staging, WHO histopathology and the completeness of resection are important prognostic factors.
胸腺瘤是一种胸腺上皮来源的肿瘤,它具有潜在恶性,同时常有多种合并症,最常见是胸腺瘤病人合并重症肌无力,其它可以合并多种副肿瘤综合症等。由于胸腺瘤的淋巴转移和血行转移少见,因此在TNM分期上至今仍存在着争议。胸腺瘤的治疗具有多样性,单纯良性胸腺瘤瘤依靠外科手术切除即可治愈,而侵袭性胸腺瘤的治疗方法常根据医生的意愿所决定。对胸腺瘤病人合并重症肌无力或合并其它副肿瘤综合症的病人,其治疗方案更加复杂化。本文收集我院近年七年来外科手术治疗的胸腺瘤病例174例,将收集的资料进行统计分析和总结,以探讨胸腺瘤的现状和手术疗效。
资料与方法
1.收集我院2003年1月至2010年12月经手术切除和病理证实的胸腺瘤病例共174例,分别按WHO分类法、Masaoka分期标准、MGFA重症肌无力临床分型法进行归类和统计,结果采用SPSS17.0统计学软件,计数资料相关分析通过X2检验,生存分析用Kaplan-Meier检验。
2.对174例胸腺瘤手术患者根据联系信息逐一进行了术后电话采访,部分病人进行门诊随访,其中失访43例,得到有效随访131例,分别统计单纯胸腺瘤组1年、3年、5年生存率和胸腺瘤合并重症肌无力组1年、3年、5年生存率,同时根据Masaoka分期统计各分期的5年生存率和按WHO分类法统计各组织学类型的5年生存率,并进行统计学分析。
结果
根据WHO胸腺瘤分类法,本组A型30例(18%)；AB型50例(28%)；B1型26例(15%)；B2型43例(25%)；B3型19例(11%)；C型6例(4%)。良性：恶性=46：54。按Masaoka分期标准：本组Ⅰ期69例(39%),ⅡA期33例(19%),ⅡB期22例(13%),Ⅲ期35例(19%),ⅣA期12例(8%),ⅣB期3例(2%)。本组以Ⅰ、Ⅱ期为多见。胸腺瘤合并重症肌无力61例(35%),按MGFA的临床分型评价重症肌无力的严重程度。Ⅰ型16例(26%),Ⅱ型28例(46%),Ⅲ型17例(28%),Ⅳ型0例,Ⅴ型0例。胸腺瘤合并重症肌无力本组多见于B型,其中以B2型为最多(44%)。胸腺瘤完整切除者157例,部分切除患者17例,无手术死亡病例。
术后随访统计131例资料,死亡26例,其中9例因胸腺瘤复发及重症肌无力死亡,7例因心脑血管意外死亡,3例因肺部并发症死亡,7例死因不详。按Masaoka分期,5年生存率分别为Ⅰ期100%,Ⅱ期98%,Ⅲ期82%,Ⅳ期52%,各分期比较差异有统计学意义(X2=39.87,P<0.01)。按WHO分型,5年生存率分别为A型100%,AB型95%,B1型84%,B2型81%,B3型79%,C型56%,有统计学差异(X2=0.98,P<0.05)。
结论
1.本组胸腺瘤手术患者良性与恶性比例46：54,相差不大。
2.本组胸腺瘤伴重症肌无力约占1/3(61/174),组织学类型多见于B型(79%),其中以B2型为多见(44%),临床分型则以全身型为主,病理类型与重症肌无力的严重程度无关联。
3.本组胸腺瘤治疗以手术切除为主,无手术死亡,即使是合并重症肌无力或恶性胸腺瘤,手术仍是安全的,术后疗效满意。
4.胸腺瘤预后与手术完整切除、Masaoka分期、以及WHO组织病理学分类有关。
Background:Thymoma is originated from the thymic epithelium. It is potentially malignant and can be accompanied by various complications. The most common complication was myasthenia gravis(MG) and it is often associated with some paraneoplastic syndromes. Like any tumors, adopting TNM staging system for thymoma is still controversial, because it is rarely metastasize to lymph nodes and other organs. Treatment of thymoma are various, only thymectomy is enough for benign thymomas, but for invasive thymoma, it usually depends on the surgeon's desire. Treatment options for myasthenic thymoma is more complicated. In this study, we statistically analyzed 174 thymoma patients, presented current management options and role of surgery.
Materials and Methods:
We have retrospectively analysed thymoma patients who were surgically resected and histopathologically proved as thymoma between Jan.2003 and Dec.2010. We presented thymoma patients by adopting Masaoka staging system, WHO hispopathologic classofication and MGFA classification.SPSS 17.0 was used for statistical analysis.
Results:
Thymomas were classified according to WHO hispopathologic classofication, type A thymoma (18%), type AB 50 (28%), type B1 26 (15%), type B2 43 (25%), type B3 19 (11%), and type C 6(4%), benign to malignant ratio was 46:54. Thymomas were staged by Masaoka staging system, StageⅠ69 (39%), StageⅡA 33 (19%), StageⅡB 22 (13%),Ⅲ35 (19%), StageⅣA12 (8%) and StageⅣB 3 (2%). In our series, stageⅠandⅡwere more common than other stages. Among them,61 patients were myasthenic thymoma, we grouped them by MGFA classification system into 5 groups, ClassⅠ16 (26%), ClassⅡ28 (46%), Class in 17 (28%), Class IVand ClassⅤwere 0. Type B thymoma are more associated with MG, B2 is the most common type, accounted for 44% of all mysthenic thymoma.157(90%) thymoma patients had complete resection, and 17(10%). of them had incomplete resection. There were no surgery related deaths. We conducted postoperative follow-up for 131 patients,26 were died. Among them 9 were died because of the recurrence and MG,7 were died of cardiovascular events,3 were died of pulmonary infection,7 were died of unknowed reason. Patients were followed up by Masaoka staging system, the 5-year survival rates were 100% for StageⅠ,98% for StageⅡ,82% for StageⅢ,52% for Stage IV respectively. Result of Masaoka staging system evidence was statistically significant (X2=39.87, P<0.01). Patients were followed up by WHO pathologic classification system, the 5-year survival rates were 100% for type A,95% for type AB,84% for type B1,81% for type B2,79% for type B3 and 56% for type C respectively. Result of WHO pathologic classification system evidence was statistically significant (X2=0.98, P<0.05).
Conclusion:
1. In our study, benign to malignant ratio was 46:54, no significant differences.
2. In our study, myasthenic thymoma accounts for 1/3 of all thymoma patients, major histopathological type is B2, most of them were generalized MG. There were no correlation between the severity of MG and thymoma histopathology.
3. In our study, the main treatment option was surgery, there were no surgery related death, surgery is still the mainstay treatement for mysthenic and invasive thymoma, we achieved a satisfactory result for such patients.
4. Thymoma Masaoka staging, WHO histopathology and the completeness of resection are important prognostic factors.
引文
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[14]Cakar F, Werner P, Augustin F, Schmid T, et al:A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis. Eur J Cardiothorac Surg 2007; 31:501-504.
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[2]Tormoehlen LM, Pascuzzi RM. Thymoma, myasthenia gravis, and other paraneoplastic syndromes. Hematol Oncol Clin North Am 2008;22(3):509—26.
[3]Evoli A, Minicuci GM, Vitaliani R, Battaglia A, Della Marca G, Lauriola L, Fattorossi A. Paraneoplastic diseases associated with thymoma. J Neurol 2007;254:756—62.
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