126例胸腺瘤伴重症肌无力患者临床特点及预后

目的 探讨胸腺瘤伴重症肌无力患者的临床特点及预后。方法 回顾分析2008—2014年经术后病理证实的126例胸腺瘤伴重症肌无力患者的临床病理资料。Kaplan-Meier法计算生存率,Logrank法单因素预后分析,Cox法多因素预后分析。结果 全组3、5年样本量分别为88例、45例。3、5年生存率分别为97.9%、91.8%。WHO分型中A+AB+B1+B2型与B3型患者3、5年生存率分别为98.6%与95.2%、90.6%与92.9%(P=0.764)。Masaoka分期Ⅰ+Ⅱ期与Ⅲ+Ⅳ期患者3、5年生存率分别为98.6%与95.2%、97.4%与72.7%(P=0.791)。完整切除与部分切除患者3、5年生存率分别为97.8%与91.7%、100.0%与50.0%(P=0.964)。单纯完整切除与完整切除+术后放疗患者3、5年生存率分别为96.8%与93.1%、100.0%与94.7%(P=1.000)。结论 胸腺瘤伴重症肌无力患者应尽可能行完整手术切除,术后根据具体情况给予放疗。完整切除、术后放疗、WHO分型、Masaoka分期可能与预后有关。

Clinical features and prognosis of thymoma with myasthenia gravis: an analysis of 126 patients

Objective To investigate the clinical and pathological features and prognostic factors for thymoma with myasthenia gravis (MG).Methods The clinical and pathological data of 126 patients with thymoma and MG confirmed by postoperative pathological examination from 2008 to 2014 were analyzed retrospectively.The Kaplan-Meier method was used to calculate survival rates;the log-rank test was applied for univariate prognostic analysis;the Cox regression model was applied for multivariate prognostic analysis.Results The numbers of patients who received the follow-up visits at 3 and 5 years were 88 and 45,respectively (the patients who were admitted before the end of October 2011 and the end of October 2009).The 3-and 5-year survival rates were 97.9％ and 91.8％,respectively.The 3-and 5-year survival rates for patients with WHO types A+AB+B1 +B2 and B3 were 98.6％/95.2％ and 90.6％/92.9％,respectively (P=0.764),and those for patients with Masaoka stages Ⅰ-Ⅱ and Ⅲ-Ⅳ were 98.6％/95.2％ and 97.4％/72.7％,respectively (P=0.791).The 3-and 5-year survival rates for patients with complete and partial resection were 97.8％/91.7％ and 100.0％/50.0％,respectively (P=0.964),and those for patients with complete resection alone and complete resection+postoperative radiotherapy were 96.8％/93.1％ and 100.0％/94.7％,respectively (P=1.000).Conclusions The major treatment modality for thymoma with MG is complete resection followed by radiotherapy according to the specific circumstances after surgery.Complete resection,postoperative radiotherapy,WHO type,and Masaoka stage may be associated with prognosis.