单纯胸腺瘤与胸腺瘤合并重症肌无力患者的外科治疗及预后分析
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南京医科大学第一附属医院

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国家自然科学基金项目(面上项目,重点项目,重大项目),吴阶平医学基金课题,临床能力提升工程医疗面上项目


Surgical treatment and prognosis analysis of thymoma and thymoma with myasthenia gravis
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    摘要:

    目的 探讨外科治疗单纯胸腺瘤患者与合并重症肌无力的胸腺瘤患者的临床、病理的差异及预后分析。方法 回顾性分析2008-2018年于我科接受手术治疗的胸腺瘤患者的临床和术后病理资料,对比分析单纯胸腺瘤患者与合并重症肌无力胸腺瘤患者之间的围术期疗效及远期预后之间的差异。结果 共有354例患者纳入本研究。单纯胸腺瘤组301例患者,男性139例,女性162例,平均年龄54.11±12.57岁,平均肿瘤直径6.42±2.94cm,Masaoka分期Ⅰ期147例(48.8%)、Ⅱ期68例(22.6%)、Ⅲ期15例(5.0%)、Ⅳ期71例(23.6%),腔镜手术比例55.5%,R0切除比例96.3%,后续治疗患者比例21.9%。胸腺瘤合并重症肌无力组共53例患者,男性31例,女性22例,平均年龄53.74±10.21岁,平均肿瘤直径5.12±2.11cm,Masaoka分期Ⅰ 期24例(45.3%)、Ⅱ期16例(30.1%)、Ⅲ期4例(7.6%)、Ⅳ期9例(17%),腔镜手术比例56.6%,R0切除比例98.1%,后续治疗患者比例13.2%。两组术后OS(Overall survival)差异无统计学意义。多因素分析提示:年龄≥55岁、肿瘤直径≥6cm、术后病理分型为B型、Masaoka分期Ⅲ-Ⅳ期及需要后续治疗是影响胸腺瘤患者预后的独立因素。结论 相比单纯胸腺瘤,胸腺瘤合并重症肌无力患者更年轻,肿瘤直径更小。完整性切除是改善胸腺瘤患者预后的重要因素,术后准确的病理分型及分期可以更好的预测患者预后。

    Abstract:

    Objective: To explore the clinical characters, pathological, and prognostic distinctions between Thymoma patients with and without myasthenia gravis(MG). Methods: We undertook a retrospective study of patients treated for Thymoma at a single institution from 2008 to 2018. The patients were divided into two groups according to the presence or absence of MG. The surgical efficacy, pathological stage, and survival rate were compared and analyzed between patients with and without MG. Results:354 patients met our inclusion criteria. Patients were categorized into two groups based on whether they had MG. A total 301 patients in group without MG, including 139 males and 162 females, had an average age of 54.11±12.57 years, and an average tumor diameter of 6.42±2.94cm. In group without MG, there were 147 cases (48.8%) in Masaoka stage Ⅰ, 68 cases (22.6%) in stage Ⅱ, 15 cases (5.0%) in stage Ⅲ, 71 cases (23.6%) in stage Ⅳ. A total 53 patients in group with MG, including 31 males and 22 females, had an average age of 53.74±10.21 years, and an average tumor diameter of 53.74±10.21cm. In group with MG,there were 24 patients in Masaoka stage Ⅰ (45.3%), 16 patients in stage Ⅱ (30.1%), 4 patients in stage Ⅲ (7.6%), and 9 patients in stage Ⅳ (17%). There was no significant difference in Overall survival (OS) between two groups. Multivariate analysis suggested that age ≥55 years old, tumor diameter ≥6cm, postoperative pathological type B, Masaoka stage Ⅲ-Ⅳ, and the need for follow-up treatment were risk factors affecting the prognosis of thymoma patients. Conclusion:Patients with thymoma and MG are younger and have a smaller tumor diameter than those without MG. Complete resection is crucial for improving the prognosis of thymoma patients, while accurate postoperative pathological classification and staging can enhance prognostic prediction.

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  • 收稿日期:2023-05-31
  • 最后修改日期:2023-07-26
  • 录用日期:2023-10-20
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