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胸腺瘤1470例临床病理分析

已有 647 次阅读2021-1-26 18:42 |个人分类:TET学习|系统分类:医学科学| 胸腺瘤

胸腺瘤1470例临床病理分析.Thymoma: a clinicopathological correlation of 1470 cases
我们报告了来自11个国家的14个机构的病理文件中确定的1470例胸腺瘤手术切除,目的是确定胸腺瘤的简化组织学分类和病理分期与临床结果的关系。研究人群由720名男性和750名女性组成,年龄在12至86岁之间(平均54.8岁)。临床上,137例(17%)有重症肌无力病史,31例(3.8%)有其他自身免疫性疾病,55例(6.8%)有其他肿瘤病史。所有患者均行手术切除。组织学上,1284例(87.13%)为胸腺瘤(世界卫生组织A型、B1型、B2型和混合型),186例(12.7%)为非典型胸腺瘤(世界卫生组织B3型)。其中包膜完整型胸腺瘤630例(42.9%),浸润型胸腺瘤840例(57.9%)。随访1339例(91%),采用单因素和多因素统计分析。随访1~384个月(平均69.2个月),136例(10.1%)肿瘤复发,227例死亡,其中64例(28.2%)死于肿瘤,163例(71.8%)死于其他原因。统计分析显示,将这些肿瘤分为胸腺瘤和非典型胸腺瘤具有统计学意义(P=0.001),而将肿瘤分为包膜完整型、微浸润型和浸润邻近器官型的分期提供了有意义的临床评估,P=0.038。我们的研究结果表明,我们简化的组织学模式和病理分期系统是很好的预测临床结果

Abstract
We present 1470 surgical resections for thymoma identified in the pathology files of 14 institutions from 11 countries with the purpose of determining and correlating a simplified histological classification of thymoma and pathological staging with clinical outcome. The study population was composed of 720 men and 750 women between the ages of 12 and 86 years (average, 54.8 years). Clinically, 137 patients (17%) had a history of myasthenia gravis, 31 patients (3.8%) of other autoimmune disease, and 55 (6.8%) patients of another neoplastic process. Surgical resection was performed in all patients. Histologically, 1284 (87.13%) cases were thymomas (World Health Organization types A, B1, and B2, and mixed histologies), and 186 (12.7%) were atypical thymomas (World Health Organization type B3). Of the entire group, 630 (42.9%) were encapsulated thymomas, and 840 (57.9%) were invasive thymomas in different stages. Follow-up information was obtained in 1339 (91%) patients, who subsequently were analyzed by univariate and multivariate statistical analysis. Follow-up ranging from 1 to 384 months was obtained (mean, 69.2 months) showing tumor recurrence in 136 patients (10.1%), whereas 227 died: 64 (28.2%) due to tumor and 163 (71.8%) due to other causes. Statistical analysis shows that separation of these tumors into thymoma and atypical thymoma is statistically significant (P = .001), whereas tumor staging into categories of encapsulated, minimally invasive, and invasion into adjacent organs offers a meaningful clinical assessment with a P = .038. Our findings suggest that our simplified histological schema and pathological staging system are excellent predictors of clinical outcome.

Once all the cases were entered into a common database, they were stratified using the Suster-Moran schema [10] for histopathological classification into:
•Thymoma
WHO types A, B1, and B2.
Thymomas with mixed histologies (10% cutoff for any particular histology among thymomas and atypical thymoma).
•Atypical thymoma
WHO type B3.
In addition, all the cases were pathologically staged using the Moran staging system [11] into:
•Stage 0: encapsulated thymoma.
•Stage I: minimally invasive thymoma (transcapsular invasion into the perithymic adipose tissue).
•Stage IIA: tumor invading pleura, lung, or innominate vein; IIB: tumor invading pericardium; IIC: tumor invading great vessels or heart.
•Stage IIIA: invasion into the diaphragm (drop metastasis); IIIB: extrathoracic disease (below the diaphragm or above the thoracic inlet).

Weissferdt A, et al. Thymoma: a clinicopathological correlation of 1470 cases. Hum Pathol. 2018 Mar;73:7-15. doi: 10.1016/j.humpath.2017.08.018. Epub 2017 Aug 26. PMID: 28851660.

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