胸腺瘤伴重症肌无力与单纯胸腺瘤的临床与预后比较

目的 探讨胸腺瘤伴重症肌无力患者与单纯胸腺瘤患者的临床病理特点及预后。方法 回顾分析2008—2014年经病理证实的161例胸腺瘤伴或不伴重症肌无力患者(128例或33例)的临床病理资料,Kaplan-Meier法计算生存率,χ²检验或 Fisher′s 精确概率法检验差异。结果胸腺瘤伴或不伴重症肌无力患者平均发病年龄分别为45.2、48.5 岁,肿瘤直径≤5 cm、≥5 cm分别占74.2%、75.8%,Masaoka分期Ⅰ+Ⅱ、Ⅲ+Ⅳ期占78.1%、51.1%;总体3年生存率分别为98.1%、81.8%(P=1.000),5年生存率分别为91.1%、42.9%(P=0.000)。全组完整切除(140例)与非完整切除(21例)患者3年生存率分别为 97.2%与58.8%(P=0.000),5 年生存率分别为 92.7%与25.0%(P=0.000)。Masaoka 分期Ⅱ期患者中单纯完整切除(25例)与完整切除+术后放疗(25例)患者3年生存率分别为95%与100%(P=1.000),5年生存率分别为86%与100%(P=0.467)。结论 较单纯胸腺瘤患者,伴重症肌无力的胸腺瘤患者发病年龄更趋向年轻化,肿瘤直径明显偏小,Masaoka 分期较早。重症肌无力、完整手术切除是胸腺瘤患者积极的预后因素,Ⅱ期完整手术切除患者术后放疗可降低复发率。

Comparison of clinical features and prognosis between thymoma alone and thymoma with myasthenia gravis

Objective To investigate the clinicopathological features and prognosis in patients with thymoma and patients with thymoma and myasthenia gravis (MG). Methods A retrospective analysis was performed on the clinicopathological data of 161 patients pathologically diagnosed with thymoma alone or thymoma and MG from 2008 to 2014. In those patients, 128 had thymoma with MG and 33 had thymoma alone. The survival rates were calculated using the Kaplan-Meier method and analyzed using χ² test or Fisher′s exact probability test. Results The mean age of onset was 45.2 years for patients with thymoma and MG and 48.5 years for patients with thymoma alone. In patients with thymoma and MG, 74.2% had a tumor diameter of ≤5 cm, while 75.8% of patients with thymoma alone had a tumor diameter of ≥5 cm. According to the Masaoka staging system, 78.1% of patients with thymoma and MG had stage Ⅰ+Ⅱ disease, while 51.1% of patients with thymoma alone had stage Ⅲ+Ⅳ disease. There was no significant difference in the 3-year overall survival (OS) rate between the two groups (98.1% vs. 81.8%, P=1.000). The 5-year OS rate was significantly higher in patients with thymoma and MG than in patients with thymoma alone (91.1% vs. 42.9%, P=0.000). In all patients, 140 patients with complete resection had significantly higher 3-and 5-year OS rates than 21 patients with incomplete resection (97.2% vs. 58.8%, P=0.000;92.7% vs. 25.0%, P=0.000). In patients with stage Ⅱ disease, there were no significant differences in the 3-or 5-year OS rates between patients with complete resection alone (n=25) and patients with complete resection and postoperative radiotherapy (n=25)(95% vs. 100%, P=1.000;86% vs. 100%, P=0.467). Conclusions Compared with patients with thymoma alone, patients with thymoma and MG have an earlier age of onset, substantially smaller tumor diameters, and earlier Masaoka stages. MG and complete resection are positive prognostic factors for patients with thymoma. Radiotherapy after complete resection can reduce the recurrence rate in patients with stage Ⅱ disease.