胸腺瘤的外科治疗和预后分析

目的探讨外科治疗在胸腺瘤治疗中的作用及预后的影响因素。 方法回顾性分析2004年1月—2017年1月就诊于甘肃省人民医院胸外科并接受手术治疗的55例胸腺瘤患者的临床资料。生存率的计算及单因素生存分析采用Kaplan-Meier法进行，组间差异使用Log-rank检验进行计算，所有经单因素生存分析有意义的参数均纳入多因素生存，采用Cox分析确定与预后相关的因素。 结果55例胸腺瘤患者中，成功随访53例，失访2例。53例患者均接受手术治疗，中位随访时间75.3个月，1、3、5、10年生存率分别为71.1%、56.7%、39.3%和23.3%。单因素分析结果显示：临床症状、肿瘤直径、肿瘤切除范围、Masaoka分期、WHO组织学分类及放化疗对胸腺瘤患者术后长期生存率均有显著影响(P<0.01)；多因素Cox分析表明肿瘤切除方式(HR＝5.15，95% CI：1.573～16.883，P<0.05)、肿瘤直径(HR＝5.53，95% CI：1.879～11.797，P<0.05)、WHO分型(HR＝13.23，95% CI：3.015～29.230，P<0.05)、Masaoka分期(HR＝5.18，95%CI：1.597～13.737，P<0.05)以及放化疗(HR＝12.14，95% CI：2.979～49.503，P<0.05)是影响胸腺瘤术后生存率的独立因素。 结论肿瘤直径、肿瘤切除方式、WHO分型、Masaoka分期以及术后放化疗是影响胸腺瘤患者预后的独立因素。

Surgical treatment and prognostic analysis of thymoma

ObjectiveTo explore the prognostic factors affecting the long-term survival of patients with thymoma. MethodsThe clinical data of 55 patients with thymoma who were treated with thoracic surgery in Gansu Provincial People's Hospital from January 2004 to January 2017 were retrospectively analyzed. The possible prognostic factors were analyzed by univariate analysis and multivariate analysis with Kaplan-Meier method and Cox proportional hazard model, respectively. ResultsTwo cases were lost and 53 cases were followed up successfully. All 53 patients underwent surgery. All patients were followed up for 1 to 125 months, and the 1, 3, 5, 10 year survival rates were 71.1%, 56.7%, 39.3% and 23.3% respectively. The significant prognostic factors demonstrated by univariate analysis included age, clinical symptoms, tumor diameter, Masaoka staging, WHO histologic classification, completeness of resection, and chemoradiotherapy (P<0.01). According to multivariate analysis, the tumor type (HR=5.15, 95% CI: 1.573-16.883, P<0.05), tumor diameter (HR=5.53, 95% CI: 1.879-11.797, P<0.05), WHO classification (HR=13.23, 95% CI: 3.015-29.230, P<0.05), Masaoka staging (HR=5.18, 95% CI: 1.597-13.737, P<0.05) and chemoradiotherapy (HR=12.14, 95% CI: 2.979-49.503, P<0.05) are independent factors affecting the postoperative survival rate of thymoma. ConclusionsTumor diameter, tumor resection, WHO classification, Masaoka and postoperative chemoradiotherapy were independent prognostic factors.