胸腺瘤患者预后因素分析

目的 探讨影响胸腺瘤患者术后远期生存率的相关因素。方法 回顾性分析我科1973—2000年间手术治疗的69例胸腺瘤，应用Kaplan—Meier法和Cox比例风险模型对可能影响胸腺瘤术后远期生存率的因素进行单因素和多因素分析。结果 全组患者5年、10年、15年生存率分别为83．3％、67．4％、41．9％。单因素分析显示年龄、Masaoka分期、WHO组织学分类、肿瘤切除范围、Rosai／Levine分类对胸腺瘤患者术后长期生存率有显著影响(P＜0．01)，但经多因素分析表明仅Masaoka分期(P＜0．01)、肿瘤切除范围(P＜0．05)、年龄(P＜0．05)是独立的预后因素。结论 对胸腺瘤应积极进行手术治疗，即使姑息性切除亦有助于提高远期生存。     

62例肺类癌的外科治疗及预后

目的 总结肺类癌的外科治疗经验并分析影响预后的因素.方法 回顾性分析2000年1月至2010年10月收治的62例肺类癌临床资料,分别对性别、年龄、吸烟史、肿瘤家族史、组织类型、TNM分期等进行单及多因素预后分析.结果 全组无手术死亡.1例手术当日因血胸行再次剖胸止血;1例左下肺切除者术后2周发生支气管胸膜瘘急诊行支气管残端修补加网膜填塞术,术后2周痊愈出院;1例右上叶支气管袖状切除者术后0.5年吻合口瘢痕增生致右余肺不张行右余肺切除术.患者3年、5年生存率分别为92.1％、77.8％,好于其他类型肺癌.42例典型类癌患者中4例(8.3％)淋巴结转移,均为N1,术后3年生存率为97.8％,5年生存率为94.7％;20例不典型类癌中6例(37.5％)淋巴结转移,4例N1,2例N2,术后3年、5年生存率分别为84.4％、58.8％.典型类癌患者和不典型类癌患者3、5年生存率差异有统计学意义(P =0.0047),有、无淋巴结转移患者3、5年生存率差异有统计学意义(P =0.0048).多因素分析显示,影响预后的独立因素是病理类型(P =0.038)及有无淋巴结转移(P =0.023).结论 原发性肺类癌预后好于其他肺癌,确诊主要依靠术后病理诊断,根治性手术是主要治疗手段,对中央型肺类癌应首选袖状切除术.影响其预后的独立因素是病理类型(P =0.038)及有无淋巴结转移(P =0.023).     

41例原发性胸腺癌的临床特点及手术效果分析北大核心CSCD

目的总结胸腺癌的临床特点,探讨其手术治疗的效果,并分析与胸腺癌外科治疗术后预后相关的危险因素。方法回顾性分析2001年12月~2015年7月我院手术且病理确诊的41例胸腺癌患者资料,分析临床表现及影像学特点,并对全组患者进行随访,观察手术效果。结果术后病理鳞癌29例,不典型类癌5例,典型类癌4例,小细胞癌2例,肉瘤样癌1例。采用Masaoka分期系统对胸腺癌进行分期：Ⅰ期9例,Ⅱ期6例,Ⅲ期15例,Ⅳ期11例。R0切除26例,姑息性切除9例,探查活检6例。全组随访38例,失访3例,失访率7.3%。中位随访时间48个月（1~151个月）,3年、5年和10年总生存率分别为88.0%、81.5%和53.2%,3年、5年和10年无复发生存率分别为80.2%、68.2%和35.1%。单因素分析显示是否R0切除是影响胸腺癌术后复发的因素（P=0.029）,术后Masaoka分期（P=0.031）和是否R0切除（P=0.044）是影响胸腺癌患者术后生存的因素。结论胸腺癌的常见临床症状为胸背部疼痛及胸闷,其手术切除术后效果相对较好,Masaoka分期和是否R0切除是影响胸腺癌患者术后生存的危险因素。     

41例原发性胸腺癌的临床特点及手术效果分析

目的总结胸腺癌的临床特点,探讨其手术治疗的效果,并分析与胸腺癌外科治疗术后预后相关的危险因素。方法回顾性分析2001年12月~2015年7月我院手术且病理确诊的41例胸腺癌患者资料,分析临床表现及影像学特点,并对全组患者进行随访,观察手术效果。结果术后病理鳞癌29例,不典型类癌5例,典型类癌4例,小细胞癌2例,肉瘤样癌1例。采用Masaoka分期系统对胸腺癌进行分期:Ⅰ期9例,Ⅱ期6例,Ⅲ期15例,Ⅳ期11例。R0切除26例,姑息性切除9例,探查活检6例。全组随访38例,失访3例,失访率7.3%。中位随访时间48个月(1~151个月),3年、5年和10年总生存率分别为88.0%、81.5%和53.2%,3年、5年和10年无复发生存率分别为80.2%、68.2%和35.1%。单因素分析显示是否R0切除是影响胸腺癌术后复发的因素(P=0.029),术后Masaoka分期(P=0.031)和是否R0切除(P=0.044)是影响胸腺癌患者术后生存的因素。结论胸腺癌的常见临床症状为胸背部疼痛及胸闷,其手术切除术后效果相对较好,Masaoka分期和是否R0切除是影响胸腺癌患者术后生存的危险因素。     

非转移性肾细胞癌的术前危险分层

目的 探讨建立一种非转移性肾细胞癌(RCC)术前危险因素的评价模型. 方法 回顾性分析了3个中心实施手术治疗的363例非转移性RCC患者资料,Cox比例风险模型进行单因素和多因素分析,评价影响患者生存期的临床以及病理变量,并建立再现风险公式(RRF). 结果 363例平均随访46个月,2年及5年总体生存率为90%(326/363)及54%(196/363),术后复发71例.Cox单因素分析中4个变量对预后有影响,即临床表现(RR=50.583,P=0.000)、肿瘤大小(RR=104.018,P-0.000)、肿瘤分期(RR-135.145,P=0.000)、分级(RR=86.397,P=0.000).Cox多因素分析中,临床表现(RR=6.946,P=0.008)、肿瘤大小(RR=9.353,P=0.002)、分期(RR=69.580,P=0.000)、分级(RR=15.363,P=0.000)仍然对预后具有明显影响.通过Cox多因素分析结果建立了RRF(0.530×临床表现+0.749×肿瘤大小).等式分组后,RRF≤1.3组的2年及5年生存率为100.0%(147例)及71.3%(105例),RRF＞1.3组的2年及5年生存率为82.8%(179例)、38.1%(82例),2组预后差异有统计学意义(P＜0.01). 结论 建立了一个独立于分期、分级,仅使用术前变量对非转移性RCC危险分层的公式.RRF有助于术前判断患者预后以及实施个体化随访和辅助治疗方案.     

185例胸腺瘤的临床特点

目的 探讨胸腺瘤及胸腺瘤合并重症肌无力(MG)的临床特征.方法 回顾分析1979年10月～2004年7月外科治疗的185例胸腺瘤患者的临床资料,其中单纯胸腺瘤94例(胸腺瘤组),胸腺瘤合并MG 91例(胸腺瘤合并MG组);手术根治性切除155例(83.8%),姑息性切除16例(8.6%),探查术14例(7.6%).分析两组患者的临床特点;按Masaoka病理分期法进行分期,运用寿命表法计算生存率,分析影响预后的因素.结果 术后死亡5例,其余均缓解或治愈.两组患者的Masaoka病理分期差异有统计学意义(χ2=53.14,P＜0.05);胸腺瘤病理分型与MG临床分型、病理分期差异无统计学意义(χ2=8.21,P＞0.05).胸腺瘤组随访57例,随访1～10年,平均随访40.7个月,1、3、5年生存率分别为70.2%(40/57)、66.7%(22/33)、59.3%(16/27);胸腺瘤合并MG组随访55例,1、3、5年生存率分别为98.2%(54/55)、86.4%(38/44)、81.6%(31/38),比较两组1、3、5年生存率差异无统计学意义(χ2=0.83,P＞0.05).随访112例中,Masaoka病理分期5年生存率分别为Ⅰ期93.7%,Ⅱ期79.2%,Ⅲ期51.4%,Ⅳ期0%,各分期比较差异有统计学意义(χ25年=51.62,P＜0.01).结论 胸腺瘤的病理类型与MG的临床分型无关,胸腺瘤术后生存率与分期显著有关,与是否合并MG无关.胸腺瘤伴MG以全身型为主,病理类型以淋巴细胞型常见.胸部CT检查有助于早期发现胸腺瘤.治疗原则应尽可能广泛切除肿瘤,术后根据具体情况辅以放疗、化疗.手术方式、病理分期对预后影响较大.     

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

目的探讨术后放疗在Ⅱ、Ⅲ期胸腺肿瘤中的应用价值。方法回顾性分析中国胸腺肿瘤研究协作组(ChART)数据库中1994年4月至2013年3月间的接受手术治疗的Ⅱ期及Ⅲ期胸腺肿瘤病例共870例,最终共有548例符合条件纳入分析,分为术后放疗组(347例)和术后未放疗组(201例)。Kaplan-Meier法分析预后,Cox风险回归模型进行多因素生存分析。结果病理类型、MasaokaKoga分期和手术根治性是胸腺肿瘤主要的预后影响因素。接受根治性手术的胸腺肿瘤患者术后放疗组与未术后放疗组患者的5年、10年生存率分别为87.7%±2.5%、87.8%±4.0%和80.8%±3.6%、83.8%±5.4%,差异无统计学意义(P=0.529,log-rank检验)。接受姑息手术的胸腺肿瘤患者术后放疗组与未术后放疗组的5年、10年生存率分别为73.4%±6.1%、40.4%±15.5%和46.3%±12.4%、40.4%±15.5%,差异有统计学意义(P=0.017,log-rank检验)。胸腺癌患者术后放疗组与未术后放疗组的5年、10年生存率分别为79.3%±3.9%、65.4%±11.1%和49.2%±10.6%、54.5%±13.6%,差异无统计学意义(P=0.054,Breslow检验)。结论术后放疗未能改善根治性胸腺肿瘤的预后,但能改善胸腺瘤姑息切除患者的预后,并有改善胸腺癌患者预后的趋势。     

消化道类癌的诊断与治疗及其预后分析

目的探讨消化道类癌的诊断和治疗方法及影响预后的因素。方法对我院1973年12月至2002年12月间收治的消化道类癌的临床资料进行回顾分析。结果35例患者男女比例2∶1,平均年龄52岁。主要临床表现为腹痛、腹部肿块、消化道出血和梗阻。肿瘤位于结肠13例,胃11例,直肠7例,阑尾2例,小肠和十二指肠各1例。肿瘤直径2cm以下者4例,超过2cm者31例,最大直径6cm。根治性切除30例,术后5年生存率为(57.3±11.0)%;姑息性切除5例,术后5年生存率为0。肿瘤大小及浸润深度与淋巴结转移相关。结论消化道类癌较为少见,无特异性表现,极少伴类癌综合征。手术治疗预后较好,切除的彻底性是影响预后的主要因素。     

胸腺癌

对外科手术及病理证实的１４例胸腺癌进行回顾性分析，旨在提高对胸腺癌临床表现、诊断方法和外科处理的认识。大多数胸腺癌病人表现有胸痛或胸部不适等非特异性症状，但不合并胸外综合征。胸腺癌肿瘤较大、多侵犯周围脏器，手术切除率低。本组２例肿瘤完整切除，７例部分切除，５例行开胸探查，无手术死亡。除胸内广泛浸润外，胸腺癌常发生胸外转移，故预后很差。１４例术后均行辅助治疗，死亡１０例；其中５例于术后１年内死亡，３例死于术后２年，另２例分别于术后５、８年死亡；现生存４例。作者强调胸腺癌比胸腺瘤恶性程度高，预后差，应早期诊断，彻底手术切除；术后辅以放疗和化疗，以提高治疗效果。     

胸腔镜胸腺扩大切除治疗重症肌无力(附27例报告)

目的探讨胸腔镜胸腺扩大切除术治疗重症肌无力的可行性和疗效。方法2005年8月~2007年6月,对27例重症肌无力行电视胸腔镜下经右胸前侧径路胸腺扩大切除(VATS组),切除范围包括全胸腺组织到前纵隔和上纵隔所有脂肪组织。并与2004年5月~2005年7月27例胸骨劈开胸腺切除(胸骨劈开组)相对比。结果VATS组26例顺利完成手术;1例因电凝钩伤及头臂静脉干中转开胸止血。与胸骨劈开组比较,VATS组术中出血少[(46.0±5.7)mlvs(120.0±18.8)ml,t=-19.231,P=0.000],术后需镇痛例数少(3vs12,χ2=7.068,P=0.008),术后住院时间短[(7.0±1.2)dvs(11.0±2.5)d,t=-7.379,P=0.000]。2组手术时间、重症肌无力危象、疗效均无显著差异(P>0.05)。结论经右胸前侧径路胸腔镜下行胸腺扩大切除治疗重症肌无力在技术上可行,具有创伤小、疼痛轻、并发症少、住院时间短、恢复快等优点,但对MG的远期疗效尚需进一步观察。     

Atypical carcinoid of the esophagus: report of a case.

We present a case of an atypical carcinoid in the midthoracic esophagus. Esophagectomy was performed with a three-incisional approach. Although both postoperative chemotherapy and radiation therapy were given, the patient died 11 months postoperatively of liver metastasis and cachexia. We suggest that the aggressive behavior of atypical carcinoid of the esophagus precludes the use of limited surgical resection and requires adjuvant chemoradiotherapy.     

胸腺癌的外科治疗与预后

目的探讨和评价对胸腺癌的临床表现、诊断、手术方法和术后辅助治疗的认识,以提高治疗效果。方法回顾性分析北京协和医院胸外科1961年6月~2004年6月手术治疗43例胸腺癌患者的临床结果;43例患者中完全切除15例,部分或大部分切除23例,开胸探查肿瘤活检5例。结果所有肿瘤均无完整包膜并侵犯周围器官,依次为心包、上腔静脉、左右无名静脉、胸膜、膈神经和肺。全组患者无手术死亡。经6个月至18年的随诊,随访率83.72%(36/43),术后1年内死亡8例,2年内死亡4例,术后5年和8年分别死亡2例和1例。按寿命表法计算1、3、5和8年存活率分别为68.29%、56.67%、41.56%和27.71%。结论胸腺癌与恶性胸腺瘤在临床表现、影像学特点、病理类型和预后诸方面均有明显不同,胸外科医师应予以区别;CT检查是重要的诊断方法。彻底切除肿瘤以及受侵的组织和器官,甚至切除上腔静脉人工血管置换可以明显提高患者的长期存活率。胸腺癌术后除放疗外,还需要进行全身化疗,以铂类为基础的第3代化疗药可有效地改善治疗效果。     

Is thoracoscopic surgery justified to treat pulmonary metastasis from colorectal cancer?

We retrospectively analyzed 143 consecutive patients undergoing pulmonary resection for metastasis from colorectal cancer, either through thoracotomy or thoracoscopy from 1987 to 2005. Patients with incomplete resection were excluded. Patients were divided into two groups, based on whether or not they underwent thoracoscopy (n=72) or open thoracotomy (n=71) at the first pulmonary metastasectomy. Two patients undergoing thoracoscopy died postoperatively (one from pulmonary thromboembolism and one from gastrointestinal bleeding). Factors influencing postoperative recurrence-free or overall survival were multiple pulmonary metastasis and history of liver metastasis by univariate analysis, and multiple pulmonary metastasis, hilar or mediastinal nodal metastasis, larger diameter of the pulmonary metastasis, and surgery by wedge resection by multivariate analysis. Five-year recurrence-free rates after the first pulmonary metastasectomy were 34.4% in thoracoscopy and 21.1% in thoracotomy, respectively (P=0.047). Overall 5-year survival rates were 49.3% in thoracoscopy and 39.5% in thoracotomy, respectively (not significant). We found no significant difference in the survival rates between the thoracotomy and thoracoscopy groups, even with elimination of the patients with multiple pulmonary metastases in both groups. We suggest that thoracoscopic surgery for pulmonary metastasectomy from colorectal cancer may be justified if the surgical treatment is indicated.     

Bronchial adenoma: a review of 51 patients

The cases of 51 patients with bronchial adenomas were reviewed. There were 43 bronchial carcinoids, 5 adenoid cystic carcinomas, 2 mixed tumors, and 1 mucoepidermoid carcinoma. The carcinoid group was divided into typical (31, 72%) and atypical (12, 28%) subgroups. Nine carcinoids (20%) were categorized as metastasizing adenomas; in this group, 7 lesions were atypical and 2 were typical. Thirty-two lobectomies, 7 bilobectomies, 8 pneumonectomies, 2 sleeve resections, and 2 tracheal resections were performed. Ten-year survival was 88% for patients with typical carcinoids and 59% for those with atypical carcinoids. In the group with adenoid cystic carcinoma, 1 patient died postoperatively, 1 had recurrence of the tumor, 2 were alive and free from disease 16 and 23 years later, and 1 died of heart disease at 11 years. The patient with mucoepidermoid carcinoma was alive without recurrence 15 years after operation. In conclusion, bronchial adenomas of the carcinoid type are potentially malignant. Their prognosis depends on the histology of the tumor, and on the presence of metastasis to the regional lymph nodes and distant organs.     

Long-term outcome after resection for bronchial carcinoid tumors.

OBJECTIVES: We sought to determine the long-term survival of patients treated for bronchial carcinoid tumors and whether lesser resections have had an effect on outcomes. METHODS: We conducted a retrospective, multi-institutional review of patients treated surgically for primary bronchial carcinoid tumors since 1980. Operative approach, pathologic stage, histology, surgical complications, tumor recurrence, and long-term survival were assessed. RESULTS: There were 50 men and 89 women with a mean age of 52.2+/-17.4 and 58.9+/-13.3 years, respectively (P=0.021). Men were more likely to be current or former smokers than were women. Operations included lobectomy or bilobectomy in 110, pneumonectomy in four, wedge resection in 22, and bronchial sleeve resection only in three patients; resection was performed thoracoscopically in six patients. One patient died postoperatively. Stages were I, 121; II, nine; III, six; and IV, three. Typical carcinoid tumors were stage I in 100 and more advanced (stages II-IV) in nine, whereas atypical carcinoid tumors were stage I in 18 and more advanced in eight (P=0. 002). Median follow-up was 43 months (range 1-149) during which 21 (15%) patients died (four from recurrent cancer) and 19 patients (14%) were lost to follow-up. Recurrent cancer developed in 2/98 patients with typical and 5/25 patients with atypical subtypes (P<0. 001; log-rank test). The likelihood of recurrence was related to histological subtype (relative risk 7.9 for atypical carcinoid; 95% confidence interval 1.4-43.5). Five-year survival was 88% for stage I patients and was 70% for patients with more advanced stages. When stratified by stage, survival was related to age (relative risk=1.9 for a 10 year increase in age; 95% confidence interval 1.2-2.9) and possibly to the histological subtype, but not to patient gender, year of operation, or type of operation performed. CONCLUSIONS: Either major lung resection or wedge resection is appropriate treatment for patients with early stage typical bronchial carcinoid tumors. Survival is favorable for early stage tumors regardless of histological subtype. Local recurrence is more common among patients with atypical subtypes, suggesting that a formal resection may improve long-term outcome.     

胃癌同时性肝转移手术患者的预后分析

目的分析经手术治疗的胃癌同时性肝转移患者的预后因素。方法回顾性分析1998年1月至2012年12月间在大连医科大学附属第一医院胃肠外科手术治疗的胃癌同时性肝转移53例患者的临床病理学资料,对单发和多发肝转移患者的生存率进行比较并进行预后分析。结果本组53例患者5年总体生存率为11．3％。单发肝脏转移患者34例,5年生存率14．7％,明显高于19例多发肝转移患者的0（P=-0．000）。单因素分析结果显示,浆膜侵犯（P=0．000）、淋巴结转移（P=0．000）、手术根治度（P=0．044）、发生肝转移数目（P=0．000）和肝转移肿瘤直径（P=0．031）是影响胃癌肝转移患者预后的因素。其中浆膜侵犯（RR：3。355,P=0．012）和肝转移数目（RR：7．664,P=0．000）是影响胃癌肝转移患者预后的独立因素。结论手术治疗可以提高无浆膜侵犯的胃癌单发肝转移患者的预后。     

伴肝转移的Ⅳ期胃癌手术方式的合理选择

目的探讨不同手术方式对伴肝转移的Ⅳ期胃癌患者的临床疗效。方法回顾性分析1993-2004年间102例伴肝转移的Ⅳ期胃癌病例的手术方式,评价不同术式对预后的影响。结果肝转移H1的胃癌病例行姑息切除后半年、1年和2年的生存率分别为69%、44%和6%,与改道手术、开腹探查术者的生存率比较,差异有统计学意义(P=0.009)。肝转移H2的胃癌病例姑息切除术后半年、1年和2年的生存率分别为56%、13%和6%,与改道手术、开腹探查术者的生存率比较,差异无统计学意义(P=0.068)。肝转移H3的胃癌病例行姑息切除半年、1年和2年的生存率分别为25%、13%和0,与改道手术、开腹探查术者的生存率比较,差异无统计学意义(P=0.157)。有或无腹膜转移的病例,其术后生存率比较,差异亦无统计学意义(P=0.132)。结论肝转移H1的胃癌患者,无论伴与不伴腹膜转移,均应尽量行姑息性切除手术。肝转移H2、H3的Ⅳ期胃癌患者行切除性手术无益于预后。     

Thymic carcinoma with dissemination: a retrospective analysis of ten patients

OBJECTIVE: Thymic carcinoma is a rare mediastinal neoplasm with frequent pleural or pericardial dissemination. We retrospectively studied ten such cases and analyzed factors that influenced the survival of the patients. METHODS: Ten thymic carcinoma patients with dissemination have been treated since 1987. The clinical and pathological data were retrospectively reviewed. RESULTS: Pretreatment tumor biopsy was performed and demonstrated squamous cell carcinomas in nine and small cell carcinoma in one. In six of ten patients pleural or pericardial dissemination was clinically evident (cT4). These patients were basically regarded as inoperable and treated with chemotherapy and/or radiotherapy. Four other patients were diagnosed as cT3 preoperatively but were found to have dissemination at the time of thoracotomy. They underwent total resection of the thymic tumor and all visible pleural dissemination but without pericardial dissemination. Radiotherapy was performed pre-or postoperatively with or without chemotherapy. The 5-year survival rate in all patients was 42.0%. The patients with Masaoka stage IVa showed significantly better prognosis than the patients with stage IVb (MST, 69.7 months vs. 14.5 months; 5-year survival rate, 64.3% vs. 0%) (P = 0.03). The patients with cT3 disease showed significantly better prognosis (P = 0.016) than the patients with cT4 disease (MST, 69.7 months vs. 14.5 months; 5-year survival rate, 100% vs. 16.7%). CONCLUSIONS: Among thymic carcinoma patients with pleural or pericardial dissemination, there seem to be some patients who show good prognosis. These candidates are patients who underwent subtotal resection with disseminations that were identified only at the operation and without hematogenous or lymphogenous metastasis.     

Thymic carcinoid tumor--report of 3 operative cases]

Three cases of thymic carcinoid were surgically treated in our hospital. All 3 cases belonged to stage IVb (Masaoka's classification) because of anterior lymph nodes metastasis. A 44-year-old male patient died of multiple metastasis of bone and liver in 94 months after the operation. A 45-year-old female patient who had undergone operation 4 years ago, was re-operated on for recurrent carcinoid tumor but complete resection of the tumor could not be performed because of the tumorous invasion to superior vena cava, pericardium and costal bone. After the operation she has been treated by radiotherapy and any re-growth of the tumor has never been detected for 1 year. Another 50-year-old male patient who had been operated and treated by chemo-radiotherapy for thymic carcinoid before 50 months was diagnosed as recurrent tumor at left interpectoral lymph node. Radiotherapy is now preparing for this patient. 160 cases of thymic carcinoid reports in Japan were reviewed. 37 cases were stage IVb and 36 cases had supraclavicular or mediastinal lymph nodes metastasis. Those cases which had been underwent complete resection followed by radiotherapy seemed to have better prognosis. We conclude that patients of thymic carcinoid should be treated with complete resection including supraclavicular and mediastinal lymph nodes dissection, followed by radiotherapy.