刘宇①, 田野②, 张幸平③, 梁世雄①. B3 型胸腺瘤术后放射治疗的临床价值探讨[J]. 中国肿瘤临床, 2016, 43(6): 240-244. DOI: 10.3969/j.issn.1000-8179.2016.06.493
引用本文: 刘宇①, 田野②, 张幸平③, 梁世雄①. B3 型胸腺瘤术后放射治疗的临床价值探讨[J]. 中国肿瘤临床, 2016, 43(6): 240-244. DOI: 10.3969/j.issn.1000-8179.2016.06.493
Yu LIU1, Ye TIAN2, Xingping ZHANG3, Shixiong LIANG1. Clinical analysis of postoperative radiotherapy in type B3 thymoma patients[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2016, 43(6): 240-244. DOI: 10.3969/j.issn.1000-8179.2016.06.493
Citation: Yu LIU1, Ye TIAN2, Xingping ZHANG3, Shixiong LIANG1. Clinical analysis of postoperative radiotherapy in type B3 thymoma patients[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2016, 43(6): 240-244. DOI: 10.3969/j.issn.1000-8179.2016.06.493

B3 型胸腺瘤术后放射治疗的临床价值探讨

Clinical analysis of postoperative radiotherapy in type B3 thymoma patients

  • 摘要: 目的:探讨B 3 型胸腺瘤术后放射治疗的临床价值和长期生存的预后因素。方法:收集1995年10月至2008年10月在同济大学附属上海市肺科医院接受胸腺肿瘤切除术并病理诊断明确的159 例B 3 型胸腺瘤患者病历资料。按Masaoka临床分期,Ⅰ期12例,Ⅱ期33例,Ⅲ期62例,Ⅳ期52例。其中38例患者伴有重症肌无力。根治术后常规放射治疗的中位剂量50Gy。不同时期共有58例接受化疗。Kaplan-Meier 法计算总生存率、无进展生存率。Cox 回归比例风险模型用于预后多因素分析。结果:中位随访时间为52(8~125)个月,全组5 年总生存率为81.6% ,5 年无进展生存率为76.2% 。5 年局部控制率为82.6% ,复发率为32.6% ,转移率为9.3% 。结论:B 3 型胸腺瘤治疗主要失败原因是局部复发和远处转移,肺和胸膜是胸腺瘤转移复发的主要部位。术后放疗可提高晚期胸脉瘤患者的局部控制率和总生存率。Masaoka分期、手术切缘和放疗是与 5 年无进展生存率相关的独立预后因素。

     

    Abstract: Objective:To evaluate the clinical value and the prognostic factors of postoperative radiotherapy in type B 3 thymoma pa-tients. Methods:A total of 159 patients with thymoma were treated by surgery and postoperative radiotherapy. According to Masaoka staging system, 12, 33, 62, and 52patients had stage Ⅰ, Ⅱ, Ⅲ, and Ⅳlesions, respectively. Myasthenia gravis existed in 38patients. Altogether 58patients underwent chemotherapy. Overall survival, disease-free survival, and local control rates were calculated by Ka -plan-Meier method. Prognostic factors were analyzed by Cox regression model. Results:With a median follow-up of52months (8- 125 months), the overall5-year survival rate was 81. 6%. The 5-year progression-free survival rate was 76. 2%. The 5-year local control rate was 82. 6%. The recurrence rate was32. 6%, and the metastatic rate was 9. 3%. In the univariate analysis, tumor size, Masaoka stage, re -section margin, radiotherapy, and chemotherapy were significantly associated with 5-year overall survival and progression-free surviv -al (P<0. 05). In the multivariate analysis, Masaoka stage, resection margin, and radiotherapy were independent prognostic factors of 5-year progression-free survival ( P<0. 05). Radiotherapy could improve the regional control rate and the overall survival of patients in Ma-saoka stages Ⅲ- Ⅳ. Conclusion: The major failure mode for type B3 thymoma is the recurrence of pleure. Radiotherapy can improve the regional control rate and the overall survival of patients in advanced stages. Masaoka staging, surgical margin, and radiotherapy are the independent prognostic factors for type B3 thymoma treated by postoperative radiotherapy.

     

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