胸腺瘤的诊断、治疗和预后

目的：探讨影响胸腺瘤的诊断,治疗及预后的相关因素。方法：回顾性分析116例胸腺瘤的临床资料,运用寿命表法计算其生存率,以生存,复发或转移率为指标,进行研究。结果：胸部X线等影像学检查是本病诊断的主要手段,重症肌无力是最常见的伴随疾病,发生率为25．0％（29／116）。扩大胸腺及胸腺瘤切除可降低Ⅰ、Ⅱ期肿瘤的复发率（x^2=4.941,P=0.0219),放疗和化疗等综合治疗可以提高疗效。组织学分型（M－H）法与临床分期有明显的相关性,能更有效地反映胸腺瘤的侵袭性(=0.385,P=0.007),本组患者3,5,10年生存率分别为81．2％,67．9％和40．5％,肿瘤分期与生存率明显呈负相关（r=-0.897,P=0.000)。结论：肿瘤的组织类型,病理分期及综合治疗方法是影响患者预后的重要因素,伴随疾病对患者的预后无明显影响。

Diagnosis,treatment and prognosis of thymoma: analysis of 116 cases

OBJECTIVES: To study the diagnosis and treatment of thymoma and to assess prognosis factors. METHODS: The clinical data on 116 patients with thymoma were collected. A retrospective analysis was performed by comparison of their survival rates computed by the actuarial method and rate of recurrence and metastasis. RESULTS: Chest radiograph was used chiefly for the preoperative diagnosis of thymoma; myasthenia gravis (MG) (25.0%, 29/116) was the most common paraneoplastic disease. An extensive and radical resection was carried out to reduce the recurrence rate of thymoma with stage I and stage II (chi(2) = 4.941 P = 0.0219). The survival time was prolonged by postoperative radiotherapy and chemotherapy. A strong correlation was noted between the clinical stage and histologic subtype of M-H classification, by which the invasive behavior of thymoma was predicted (r = 0.385, P = 0.007). The 3-, 5-, and 10-year survival rates were 81.2%, 67.9% and 40.5%, respectively. Statistical analysis showed a significant negative correlation between stage and survival rate (r = -0.897, P = 0.0000). CONCLUSION: The prognosis of thymoma depends mainly on the histologic subtype, clinical stage and multimodality treatment rather than paraneoplastic diseases.