82例胸腺瘤新组织学分型与患者临床特征和预后的相关性分析

背景与目的:世界卫生组织(WHO)于1999年制定了新的胸腺瘤组织学分型标准。本研究探讨胸腺瘤WHO组织学分型与临床特征和预后的相关性。方法:回顾性分析82例经外科治疗的胸腺瘤患者的临床资料,经有经验的病理科医生按WHO组织学分型标准重新做出诊断,并结合患者的临床特征和预后进行分析。结果:胸腺瘤A型5例(6.1%),AB型21例(25.6%),B1型14例(17.1%),B2型12例(14.6%),B3型14例(17.1%),C型16例(19.5%)。根据Masaoka临床分期,Ⅰ期29例(35.4%),Ⅱ期13例(15.8%),Ⅲ期32例(39.0%),Ⅳa期8例(9.8%)。临床分期与组织学分型的相关性有显著性意义(χ2=47.29,P<0.001)。肿瘤外侵的程度与组织学分型的相关性也有显著性意义(χ2=30.78,P<0.001)。A﹑AB﹑B1和B2型胸腺瘤合计切除率较B3和C型胸腺瘤合计切除率高(84.6%vs.50.0%,χ2=11.29,P=0.002)。临床Ⅰ、Ⅱ、Ⅲ、Ⅳa期胸腺瘤切除术后5年生存率分别为100%、100%、69.5%和37.5%;10年生存率分别为88.1%、57.1%、47.5%和0。不同临床分期患者生存率的差异(log-rank=40.31,P<0.001)与组织学分型间生存率的差异(log-rank=16.0,P=0.007)均有统计学意义。结论:WHO组织学分型可在一定程度上反映胸腺瘤的生物学行为和临床特征,对临床诊断和治疗胸腺瘤有指导意义。

Correlations of novel histological classification of 82 thymoma patients to their clinical characteristics and prognosis

BACKGROUND & OBJECTIVE: The World Health Organization (WHO) histological classification of thymoma was published in 1999. This study was to investigate the correlations of WHO histological classification of thymoma to its clinical characteristics and prognosis. METHODS: Records of 82 thymoma patients treated with surgery were reviewed retrospectively. Histological diagnosis based on WHO classification system was made by an experienced pathologist. The correlations of WHO histological classification of thymoma to its clinical characteristics and prognosis were analyzed. RESULTS: Of the 82 cases, 5 (6.1%) were type A, 21 (25.6%) were type AB, 14 (17.1%) were type B1, 12 (14.6%) were type B2, 14 (17.1%) were type B3, and 16 (19.5%) were type C; according to Masaoka clinical staging system, 29 (35.4%) were in stage I, 13 (15.8%) in stage II , 32 (39%) in stage III , and 8 (9.8%) in stage IVa. The histological subtype of thymoma was significantly correlated with clinical stage (chi2 = 47.29, P < 0.001) and tumor invasive degree (chi2 = 30.78, P < 0.001). Complete resection rate was significantly higher in patients with type A, AB, B1 or B2 tumors than in patients with type B3 or C tumors (84.6% vs. 50.0%, chi2 = 11.29, P = 0.002). The 5-year survival rates of patients with stage I, II, III , and IVa were 100%, 100%, 69.5%, and 37.5%, respectively; the 10-57.1%, year survival rates were 88.1%, 47.5, and 0, respectively. The difference of survival rates among different clinical stages (log-rank = 40.31, P < 0.001) and histological subtypes (log-rank = 16.0, P = 0.007) were significant. CONCLUSION: To some extent, the WHO histological classification reflects the biological behavior and clinical characteristics of thymoma, and may be helpful in diagnosing and treating thymoma.