术后放疗对Ⅱ期胸腺瘤患者的影响

Role of adjuvant radiotherapy for stage Ⅱ thymoma after complete tumor resection

摘要:

摘要：目的  探讨术后放疗对Ⅱ期胸腺瘤患者的影响。方法  回顾性分析2008年1月-2015年10月经术后病理证实的78例Masaoka Ⅱ期胸腺瘤患者的临床病理资料，应用Kaplan-Meier法计算生存率并绘制生存曲线，χ2检验或Fisher精确检验进行复发风险因素分析。结果  全组患者总生存率为88.5%，3年生存率为94.9%，5年生存率为89.7%。完整切除与完整切除+术后放疗患者的总生存率分别为86.3%和92.6%，差异无统计学意义；3年生存率分别为94.1%和96.3%，差异无统计学意义；5年生存率分别为88.2%和92.6%，差异无统计学意义；完整切除患者复发率为21.6%，完整切除联合术后放疗患者的复发率为3.7%，差异有统计学意义。男性与女性患者的复发率分别为16.3%和14.3%，差异无统计学意义。年龄在21～30岁、31～40岁、41～50岁、51～60岁和>60岁患者复发率分别为15.4%、18.8%、15.4%、14.3%和11.1%，差异无统计学意义。肿瘤最大直径≤3 cm、3～5 cm、5～7 cm和﹥7 cm患者复发率分别为5.3%、15.2%、23.5%和22.2%，差异无统计学意义。世界卫生组织（WHO）分型中A型、AB型、B1型、B2型、B3型患者的复发率分别为0.0%、0.0%、7.1%、19.4%和35.7%，差异有统计学意义。合并重症肌无力（MG）与未合并MG患者的复发率分别为11.8%和29.6%，差异有统计学意义。结论  Masaoka Ⅱ期胸腺瘤患者完整手术切除后辅以放疗并不能提高生存率，但可以降低复发率；WHO分型、是否合并MG是影响Ⅱ期胸腺瘤复发的风险因素。

Abstract:

Abstract: Objective To investigate the role of adjuvant radiotherapy for stage Ⅱ thymoma after complete tumor resection. Methods The clinicopathological data of 78 patients with Masaoka stage Ⅱ thymoma confirmed by cytological examination of hydrothorax from January 2008 to October 2015 were retrospectively analyzed. The Kaplan-Meier method was used to calculate the survival rate and the survival curve was drawn. χ2 test or Fisher's exact probability test was used to analyze the recurrent risk factors. Results The overall survival rate was 88.5%, the overall 3-year survival rate was 94.9% and the 5-year survival rate was 89.7%. The overall survival rate, 3-year survival rate and 5-year survival rate in the complete resection patients and the patients receiving adjuvant radiotherapy after complete resection were 86.3% and 92.6%, 94.1% and 96.3%, 88.2% and 92.6% respectively (P > 0.05). The recurrent rates in the complete resection patients and the patients having adjuvant radiotherapy after complete resection were 21.6% and 3.7% respectively with significant difference. The recurrent rates for the male and female patients were 16.3% and 14.3% respectively without significant difference. In the patients with the age of 21-30, 31-40, 41-50, 51-60 and >60 years, the recurrent rates were 15.4%, 18.8%, 15.4%, 14.3% and 11.1% respectively; there were no significant differences. In the patients with the max tumor diameter ≤3 cm, 3-5 cm, 5-7 cm and >7 cm, the recurrent rates were 5.3%, 15.2%, 23.5% and 22.2% respectively; there were no significant differences. The recurrent rates were 0.0%, 0.0%, 7.1%, 19.4% and 35.7% in the patients with WHO type A, AB, B1, B2 and B3 respectively without significant differences. In the patients with myasthenia gravis (MG) and without MG, the recurrent rates were 11.8% and 29.6% respectively, there was significant difference. Conclusions Adjuvant radiotherapy for stage Ⅱ thymoma after complete tumor resection may not improve overall survival rate but may reduce recurrent rate. WHO type and MG are the recurrent risk factors for stage Ⅱ thymomas.