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目的分析探讨化疗在胸腺肿瘤治疗中的临床应用价值。方法回顾性分析中国胸腺肿瘤研究协作组(the Chinese Alliance of Research for Thymomas,ChART)数据库中1994年3月至2012年12月纳入的MasaokaⅢ/Ⅳa期及胸腺肿瘤化疗病例739例,初步评估不同模式化疗的临床价值,采用Kaplan-Meier法绘制不同亚组患者生存曲线,分析影响预后的因素。结果 Masaoka-Koga分期、手术的根治性和病理学类型是影响患者长期生存的主要因素。初始化疗有效率50.8%(30/59),客观缓解率11.9%(7/59)。初始化疗使R0切除率从66.6%(397/596)提高至72.9%(43/59)。Masaoka-KogaⅢ/Ⅳ期胸腺癌未术后化疗组与术后化疗组5年、10年生存率分别为71.0%、66.6%和53.5%、42.6%,两组间差异无统计学意义(χ~2=0.003,P=0.953)。Masaoka-KogaⅣ期胸腺瘤未术后化疗组与术后化疗组5年生存率分别为85.7%、76.1%,两组间差异无统计学意义(χ~2=0.030,P=0.862)。Masaoka-KogaⅢ胸腺瘤患者未术后化疗组和术后化疗组5年、10年生存率分别为92.1%、65.0%和88.1%、59.6%,未术后化疗组生存率显著优于术后化疗组(χ~2=13.294,P=0.000)。Masaoka-KogaⅢ/Ⅳ期胸腺瘤R0切除后患者未术后化疗组和术后化疗组5年生存率分别为92.8%和67.2%,未术后化疗组生存率也显著优于术后化疗组(χ~2=10.856,P=0.001)。结论初始化疗有提高R0切除率趋势,术后化疗未能改善胸腺肿瘤的总体预后,对于MasaokaⅢ期胸腺瘤和局部晚期R0切除的胸腺肿瘤患者术后化疗无益。
Objective To investigate the clinical value of chemotherapy in the treatment of thymus tumors. Methods The Masaoka Ⅲ / Ⅳa and 739 cases of thymoma and chemotherapy in the Chinese Alliance of Research for Thymomas (ChART) database from March 1994 to December 2012 were retrospectively analyzed to evaluate the different modes The clinical value of chemotherapy, using Kaplan-Meier method to draw the survival curves of different subgroups of patients, analysis of prognostic factors. Results The masaoka-koga staging, the radical and pathological type of surgery were the main factors influencing the long-term survival of patients. The initial chemotherapy was 50.8% (30/59), objective response rate was 11.9% (7/59). Initial chemotherapy increased R0 resection rate from 66.6% (397/596) to 72.9% (43/59). The 5-year and 10-year survival rates of Masaoka-KogaⅢ / Ⅳ thymectomy group and postoperative chemotherapy group were 71.0%, 66.6% and 53.5%, 42.6% respectively, with no significant difference between the two groups (χ ~ 2 = 0.003, P = 0.953). The 5-year survival rates of Masaoka-Koga stage IV thymectomy group and postoperative chemotherapy group were 85.7% and 76.1%, respectively. There was no significant difference between the two groups (χ ~ 2 = 0.030, P = 0.862). The 5-year and 10-year survival rates of patients without Masaoka-Koga Ⅲ thymoma were 92.1%, 65.0% and 88.1%, 59.6% respectively after chemotherapy and postoperative chemotherapy. The survival rate of patients without chemotherapy was significantly better than that of postoperative chemotherapy Group (χ ~ 2 = 13.294, P = 0.000). The 5-year survival rates of patients without Masaoka-KogaⅢ / Ⅳ thymoma after resection of R0 were 92.8% and 67.2% respectively, and the survival rates of non-operation chemotherapy group were significantly better than those of the postoperative chemotherapy group χ ~ 2 = 10.856, P = 0.001). Conclusions Initial chemotherapy may increase the R0 resection rate. Postoperative chemotherapy failed to improve the overall prognosis of thymus tumors, which is not beneficial for postoperative chemotherapy in patients with Masaoka stage Ⅲ thymoma and locally advanced R0 resected thymoma.