【摘要】 目的评估胸腺瘤WHO分型、Masaoka分期与其预后的相关性。方法纳入2009～2019年在复旦大学附属华山医院接受手术治疗的胸腺瘤患者468例,其中男234例、女234例,年龄21～83(49.6±18.7)岁。行胸腔镜手术132例,胸骨正中切口手术336例,平均随访时间(5.7±2.8)年。分析患者的临床资料。结果胸骨正中切口组术中出血量(178.3±133.5) mL,胸腔镜手术组术中出血量(164.8±184.1)mL,差异无统计学意义(P=0.537)。胸骨正中切口组手术时间(3.3±0.7)h,胸腔镜组手术时间(3.4±1.2)h,差异无统计学意义(P=0.376)。术后活动性出血、膈神经损伤、乳糜胸并发症在胸腔镜组分别为8例、9例、1例,在胸骨正中切口组分别为37例、31例、7例,差异均无统计学意义(P=0.102,0.402,0.320)。WHO病理分型A型、AB型、B1型、B2型、B3型和C型胸腺瘤患者5年累计无进展生存率分别为100.0%、100.0%、95.7%、81.4%、67.5%和50.0%(P<0.001)。MasaokaⅠ～Ⅳ期胸腺瘤患者5年累计无进展生存率分别为96.1%、89.2%、68.6%和19.3%(P<0.001)。伴重症肌无力患者5年累计无进展生存率为87.3%,无重症肌无力患者为78.2%(P<0.001)。胸腔镜与胸骨正中切口患者5年累计无进展生存率分别为82.4%和83.8%(P=0.904)。结论 WHO病理分型与Masaoka分期对临床预后有提示意义。伴重症肌无力胸腺瘤患者预后较好,提示早诊断和早治疗对胸腺瘤具有重要意义。更多还原

【Abstract】 Objective To assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis. Methods A total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83(49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery(VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed. Results The amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group(P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group(P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups(P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival(PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively(P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%,respectively(P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis(MG) and 78.2% in patients without MG(P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively(P=0.904). Conclusion WHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.更多还原