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目的 提出胸腺上皮肿瘤 (TET)分级标准 ,并探讨该分级与WHO组织学分型、临床分期的相关性及其临床病理学意义。方法 对 2 0 0例TET采用WHO病理分型和Masaoka临床分期 ,结合临床治疗和随访资料进行了系统的相关性研究并进行了TET分级。结果 胸腺瘤A型 8例(4 0 % ) ,AB型 6 8例 (34 0 % ) ,B1型 17例 (8 5 % ) ,B2型 39例 (19 5 % ) ,B3型 2 7例 (13 5 % ) ,C型 36例 (18 0 % ) ,其他 5例 (2 5 % )。组织学分型与预后的相关性有非常显著性意义 (P <0 0 0 1) ,A和AB型预后好 ,无一例患者死于肿瘤 ,B2、B3和C型较差。临床Ⅰ期 :96例 (4 8 0 % ) ,Ⅱ期 :2 6例 (13 0 % ) ,Ⅲ期 :6 5例 (32 5 % ) ,Ⅳ期 13例 (6 5 % )。临床分期与预后的相关性亦有非常显著性意义 (P <0 0 0 1) ,Ⅲ期和Ⅳ期预后较差。组织学分型与临床分期的相关性同样有非常显著性意义 (P <0 0 0 1) ,组织学分型提示在Ⅰ期、Ⅱ期TET中 ,B2、B3和C型的预后明显较其他类型差 (P <0 0 0 1)。根据TET的组织学、临床资料、生物学行为和预后情况提出了TET分级的建议 :胸腺瘤Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级 ,统计学分析表明TET分级与患者的治疗和预后的相关性有非常显著性意义 (P <0 0 0 1) ,Ⅰ级和Ⅱ级TET在根治术后仅需密切随访 ,一般不需过度
Objective To propose a thymic epithelial tumor (TET) grading standard and to explore the relevance of this grading to the histological type and clinical stage of WHO and its clinical pathological significance. METHODS: A total of 200 cases of TET were classified by WHO pathology and Masaoka clinical stage, combined with clinical treatment and follow-up data to conduct a systematic correlation study and TET classification. Results Eight cases (40%) of type A thymoma, 68 cases (340%) of type AB, 17 cases (85%) of type B1, 39 cases (19.5%) of type B2, and 27 cases of type B3 ( 13 5 %), 36 cases of C type (18 0 %), and 5 other cases (2 5 %). The correlation between histological type and prognosis was very significant (P < 0 01). The prognosis of A and AB was good. No patient died of tumor and B2, B3, and C were poor. Clinical stage I: 96 cases (48.0%), stage II: 26 cases (130%), stage III: 65 cases (32.5%), stage IV 13 cases (65%). The correlation between clinical stage and prognosis was also highly significant (P < 0 01), and the prognosis was poor in stage III and IV. The correlation between histological type and clinical stage also had very significant significance (P < 0 01). Histological type suggests that in stage I and stage II TET, the prognosis of type B2, type B3 and type C is obviously worse than that of other types. (P < 0 0 0 1). According to the histology, clinical data, biological behavior and prognosis of TET, the TET classification is proposed: thymoma grade I, grade II, grade III, and grade IV. Statistical analysis shows that TET grade is related to the treatment and prognosis of patients. Significantly significant (P < 0 01), Level I and II TET only need close follow-up after radical surgery, generally not excessive