胸腺上皮性肿瘤患者的分期相关结局

BACKGROUND:

Thymic epithelial tumours (TETs) are characterized by a wide variety of biological behaviors. Radical resection and stage are strong prognostic factors. Aim of this study is to review our Single Center Experience.

多种生物学行为是胸腺上皮性肿瘤（TETs）的主要特征。根治性切除和分期是其重要预后因素。本研究的目的是总结我们的单中心经验。

METHODS:

One hundred and seventy-seven patients observed in the period from January 2000 to December 2016 were included in the study. Data regarding clinicopathologic features, treatment, and survival were collected. Stage-related clinical standpoints and therapeutic options were also evaluated.

在2000年1月至2016年12月期间的177名被观察患者纳入该研究。收集有关临床病理特征、治疗和存活的数据。另外评估了与分期相关的临床观点和治疗选择。

RESULTS:

Non-surgical treatment was primarily performed in 15 (8.47%), unresectable disease was intraoperatively found in 12 cases (7.4%). The analysis of 150 patients undergoing curative surgery revealed 70 stage I TET (46.66%), 49 stage II (32.66%), 19 stage III (12.66%), 6 stage IVa (4%) and 6 stage IVb (4%) at the first hospital admission. Histology identified 12 A thymoma (8%), 38 AB (25.33%), 24 B1 (16%), 50 B2 (33.33%), 19 B3 (12.66%) and 7 carcinomas (4.66%). 

15例（8.47％）患者采用了非手术治疗，术中发现无法切除的患者12例（7.4％）。对首次住院的150例接受根治性手术的患者进行分析显示：70例I期TET（46.66％）、49例II期（32.66％）、19例III期（12.66％）、6例IVa（4％）和6例IVb（4％）。组织学结果包括：12例A型（8％）、38例AB型（25.33％）、24例B1型（16％），50例B2型（33.33％），19例B3型（12.66％）胸腺瘤和7例胸腺癌癌（4.66％）。

The mean follow up time was 84.14 months (sd = 61.68 months). Disease relapse occurred in 13 patients (8.78%) at a mean period of 78.85 months (sd = 60.87 months) after surgery. Exitus due to thymoma happened in 6 cases (4.05%) after a mean survival of 56.02 months (sd = 25.17 months). 

平均随访时间为84.14个月（sd = 61.68个月）。手术后平均78.85个月（sd = 60.87个月）后13例患者（8.78％）发生疾病复发。在平均存活56.02个月（sd = 25.17个月）后，6例（4.05％）胸腺瘤患者死亡。 

The 5-year overall survival rate was 0.94 (95%CI 0.88-0.97) and the 5-year disease-free survival rate was 0.90 (95%CI 0.83-0.94). The 5-year overall survival rates were 96.1% (95% CI, 89.9-98.5%) for the early stages and 87.4% (95% CI, 65.6-95.8%) for the advanced stages (p = 0.670). The 5-year disease-free survival rates resulted being 98.8% (95% CI, 92.3-99.8%) for the early stages and 59.8% (95% CI, 37.8-76.2%) for the advanced stages (p < 0.001).

5年总生存率为0.94（95％CI 0.88-0.97），5年无病生存率为0.90（95％CI 0.83-0.94）。早期患者5年总生存率为96.1％（95％CI，89.9-98.5％），晚期为87.4％（95％CI，65.6-95.8％）（p = 0.670）。 5年无病生存率在早期患者为98.8％（95％CI，92.3-99.8％），晚期阶段为59.8％（95％CI，37.8-76.2％）（p <0.001）。

CONCLUSIONS:

Advanced stage TETs are characterized by higher mortality and recurrence rates. Although technically demanding, surgery, as part of multimodality therapy, could prolong survival. Iterative surgical treatment of recurrences is a viable option for selected patients.

晚期TET的特点是死亡率和复发率较高。尽管治疗技术要求很高，但作为多模式治疗的一部分，手术可以延长生存期。 对于选定患者，复发的迭代手术治疗是可行的选择。

TRIAL REGISTRATION:

The study was approved by the Institutional Review Board of Perugia and Terni University Hospitals [Code T1003] and was retrospectively registered.

KEYWORDS:

Iterative surgery; Masaoka staging system; Oncological outcome; Surgery; Thymic carcinoma; Thymic epithelial tumours; Thymoma

迭代手术; Masaoka分期系统; 肿瘤结局; 手术; 胸腺癌; 胸腺上皮性肿瘤;胸腺瘤

Kaplan-Meier survival curves for early and advanced stages of TET. Overall survival (a) and disease free survival (b) curves for early (blue line) and advanced (red line) stages