283例胸腺瘤的综合治疗结果及预后因素分析

目的评价以手术治疗为主的综合治疗对胸腺瘤的疗效，探讨胸腺瘤患者预后的影响因素。方法283例胸腺瘤患者中，275例患者接受手术治疗，其中肿瘤完整性切除术238例，不完整性切除术14例，仅做活检23例；251例患者行放射治疗，其中术前放疗3例，单纯放疗8例，术后放疗235例，放疗＋化疗5例；76例患者在治疗的不同时期接受了化疗。Kaplan—Meier方法计算生存率和局部控制率，对可能影响患者预后的因素进行单因素分析和多因素Cox回归分析。结果283例胸腺瘤患者的中位生存时间为6．0年（0．3～32．0年），5年和10年总生存率分别为80．4％和68．4％。Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期患者的10年总生存率分别为84．3％、75．4％、56．6％和29．6％。45例患者出现复发，出现复发的中位时间为4．0年（0．4～28．0年）。70例患者发生远处转移，出现转移的中位时间为2．0年（0．3～30．0年）。性别、Masaoka分期、手术方式是患者预后的独立影响因素。结论胸腺瘤患者经过以手术治疗为主的综合治疗，可以获得较好的远期效果，性别、Masaoka分期和手术方式是影响患者预后的因素。

The long-term outcome and prognostic factors analysis of multimodality treatment for 283 patients with thymoma

Objective To study the long-term outcome and prognostic factors in patients with thymoma treated with multimodality therapy. Methods 283 patients with pathologically confirmed thymoma were enrolled into this study. Overall survival rate and local control rate were calculated. Cox regression model was used to analyze the prognostic factors. Results The 5-year overall survival rate was 94.3%, 86.3%, 71.6%, 39.4% and 80.4% for patients with stage Ⅰ,Ⅱ,Ⅲ, Ⅳ disease and all patients, respectively. The 10-year overall survival rate was 84.3%, 75.4%, 56.6% , 29.6% and 68.4% for stage Ⅰ,Ⅱ,Ⅲ, Ⅳ disease and all patients. The Masaoka staging, resection extent, and gender were independent prognositic factors in multivariate analysis. Conclusion The Masaoka staging and resection extent are independent prognositic factors in patients with thymoma treated with multimodality therapy.