137例胸腺上皮肿瘤的预后影响因素

目的：通过对胸腺上皮肿瘤患者临床、病理资料进行分析，探寻与疾病预后相关的影响因素。方法：本院心胸外科1997年6月至2007年9月胸腺上皮肿瘤病例137例，记录患者临床、病理资料，并于术后进行随访，按照Masaoka病理分期将所有病例分为Masaoka I/II期和III/IV期两组，按照WHO组织学分型将所有病例分为WHO A/AB/B1组和B2/B3/C组，应用Kaplan-Meier法、COX回归模型等寻找疾病预后的相关因素。结果：所有病例中124例（90.5%）行全切手术，9例（6.6%）行姑息性切除，4例（2.9%）行活检术。Masaoka I/II期病例中手术全切率（100％）明显高于III/IV期病例的全切率（分别为67.9%和63.6%，P＜0.001）。137例病例中总的5年、10年总生存率为71.4％和50.1％。Masaoka I/II期病例生存率明显高于III期、IV期病例(P＜0.001）；按照WHO分型，A/AB/B1型5年、10年生存率明显高于B2/B3/C型病例 (P＜0.001）；完全切除病例术后5年、10年生存率明显高于不完全切除和活检病例（P＜0.001）。COX回归分析发现，Masaoka病理分期、WHO组织学分型、肿瘤完全切除及手术时年龄与预后相关。结论：Masaoka病理分期、WHO组织学分型、肿瘤完全切除及手术时患者年龄是胸腺上皮肿瘤患者重要的预后相关因素

Prognostic factors for thymic epithelial tumor: a retrospective study of 137 cases

ObjectiveTo analyze the clinic and pathologic data of thymic epithilial tumor (TET) and to explore its prognostic factors.MethodsFrom June 1997 to September 2007, 137 patients with TET were surgically treated in our hospital. The data included age, gender, symptoms, histological type, stage and grade, pathological findings, and operation reports. The patients were followed up by telephones and mails. The patients were divided into Masaoka I/II group and III/IV group, and WHO A/AB/B1 group and B2/B3/C group. Kaplan-Meier method, log-rank test, and COX regression model were used to analyze the prognostic factors for TET.ResultsAmong the 137 patients, 124 (90.5%) received complete resection, 9 (6.6%) incomplete resection, and 4 (2.9%) surgical biopsy. The rate of complete resection was significantly higher in Masaoka stages I/II than that in stages III/IV (P＜0.001). The overall 5-year and 10-year survival rate was 71.4％ and 50.1％, respectively. Patients in stage I/II had better long-term survival than those in stage III/IV (P＜0.001). According to WHO histological classification, the 5-year and 10-year survival rate in patients with Type A/AB/B1 TET was significantly higher than that in patients with Type B2/B3/C TET (P＜0.001). The 5-year and 10-year survival rate in patients with complete resection was significantly higher than that in patients with incomplete resection and biopsy (P＜0.001).Cox regression analysis showed that the prognosis of patients with TET was related to Masaoka stage, WHO histological classification, extent of resection, and age at operation.ConclusionMasaoka stage, WHO histological classification, extent of resection, and age at operation are important prognostic factors in patients with TET.