胸腺瘤WHO分类与重症肌无力临床诊治的关系

目的:研究世界卫生组织(WHO)胸腺瘤分类法与重症肌无力(myasthenia gravis,MG)的关系及其临床意义。方法:采用WHO胸腺瘤分类法对95例胸腺瘤进行病理分类,比较胸腺瘤类型与伴发MG、肿瘤浸润性和患者预后的关系。结果:各型胸腺瘤中A型、AB型、B1型、B2型、B3型和C型胸腺瘤中伴发MG分别为16.7％、50.0％、71.4％、91.7％、66.7％和0;A型、AB型、B1型、B2型、B3型和C型胸腺瘤中发生浸润或转移者分别为16.7％、31.3％、31.4％、70.8％、100％和100％;A和AB型5年生存率为91.7％,B1型、B2型和B3型分别为84.6％、62.5％和60.0％,C型为33.3％,A型和AB型胸腺瘤患者5年生存率较B型和C型高(P<0.05,P<0.01)。结论:胸腺瘤WHO分类中B类胸腺瘤易伴发MG、浸润性强,预后差;A型胸腺瘤伴发MG少,预后好。胸腺瘤WHO分类与伴发MG密切相关,能够反映胸腺瘤的临床特征和肿瘤上皮细胞的浸润功能。

WHO classification of thymomas and its relationship with myasthenia gravis diagnosis and treatment

Objective: To study the World Health Organization (WHO) classification of thymoma and its clinical values in diagnosis and treatment of myasthenia gravis(MG). Methods: Ninety-five cases of thymomas were classified by the WHO standard and the relationship between the thymoma subtypes and MG complication, tumor invasiveness and prognosis was studied. Results: MG were associated with 16. 7%, 50. 0% ,71. 4%,91. 7%, 66. 7% and 0 patients with type A, AB, B1, B2, B3 and C thymomas, respectively. Invasive tumors were seen in 16. 7%,31. 3%,31. 4%,70. 8%,100% and 100% of type A, AB, B1, B2, B3 and C thymomas, respectively. The 5-year survival rate of A and AB types was 91. 7%, B types 73. 1% (Bl 84. 6%, B2 62. 5%, B3 60. 0%) and C type 33. 3%. The survival rates were significantly higher in patients of A and AB types than in patients of B and C types. Conclusion: B type thymoma,with greater invasiveness and poor prognosis, is often complicated with MG, whereas A type associated with MG and had better prognosis. The WHO classification of thymomas is closely related to the complication of MG and it can reflect the clinical features and the functions of thymic epithelial tumors.