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背景与目的探采用中国胸腺肿瘤协作组胸腺肿瘤多中心回顾性数据库,探讨胸腺切除范围对早期胸腺上皮肿瘤预后的影响。方法选择Masaoka-Koga分期Ⅰ期、Ⅱ期且术前没有接受新辅助治疗的患者,根据术中胸腺切除程度,分为胸腺切除组及胸腺瘤切除组。对比分析两组患者的临床特点及预后差异。结果共有1,047例患者纳入研究,其中胸腺切除组入组796例患者、胸腺瘤切除组入组251例患者。对于术前合并重症肌无力(myasthenia gravis,MG)的患者,胸腺切除组术后的MG的缓解率明显优于胸腺瘤切除组(91.6%vs 50.0%,P<0.001)。胸腺切除组的10年总体生存率(overall survival,OS)为90.9%,胸腺瘤切除组的10年OS为89.4%,两者之间没有统计学差异(P=0.732)。胸腺切除组术后复发率为3.7%,胸腺瘤切除组术后复发率为6.2%,两组之间无统计学差异(P=0.149)。进一步分层分析显示,对于Masaoka-Koga Ⅰ期患者,胸腺切除组和胸腺瘤切除组在复发率上没有差异(3.2%vs 1.4%,P=0.259);然而在Masaoka-Koga Ⅱ期患者中,胸腺切除组的复发率明显低于胸腺瘤切除组的复发率(2.9%vs 14.5%,P=0.001)。结论胸腺切除是治疗胸腺上皮肿瘤的标准手术方式,特别是对于Masaoka-Koga Ⅱ期及合并MG的患者。
BACKGROUND & AIM: To explore retrospectively the multi-center retrospective database of thymus tumor in Chinese thymoma co-operation group and explore the influence of thymic excision scope on the prognosis of early thymus tumor. Methods Patients with stage Masaoka-Koga staging Ⅰ and stage Ⅱ who were not receiving neoadjuvant therapy before surgery were divided into thymine group and thymoma group according to the extent of intraoperative thymectomy. Comparative analysis of two groups of patients with clinical features and prognosis. Results A total of 1,047 patients were included in the study, including 796 patients in the thymectomy group and 251 patients in the thymoma group. For patients with preoperative myasthenia gravis (MG), the remission rate of MG after thymectomy group was significantly better than that of thymoma group (91.6% vs 50.0%, P <0.001). The 10-year overall survival (OS) in thymectomy group was 90.9%, and the 10-year OS in thymectomy group was 89.4%. There was no significant difference between the two groups (P = 0.732). The recurrence rate was 3.7% in the thymectomy group and 6.2% in the thymoma resection group, with no significant difference between the two groups (P = 0.149). Further stratified analysis showed no difference in the relapse rate between the thymectomy group and the thymoma group (3.2% vs 1.4%, P = 0.259) for Masaoka-Koga stage I patients; however, in Masaoka-Koga stage II patients, The recurrence rate of the thymectomy group was significantly lower than that of the thymoma resection group (2.9% vs 14.5%, P = 0.001). Conclusions Thymectomy is the standard procedure for the treatment of thymic epithelial tumors, particularly in patients with Masaoka-Koga stage II and with MG.