摘要目的 研究胸腺肿瘤组织学分型与预后多因素的相关性.方法 回顾性研究108例胸腺肿瘤患者的临床病理资料,按2004年WHO胸腺肿瘤分型标准重新对肿瘤分型,根据临床和随访结果,对其预后与Masaoka临床分期、胸腺肿瘤的组织学分型、肿瘤完整切除与否、患者年龄、性别、肿瘤大小及是否伴有重症肌无力多因素进行相关性研究.结果 组织学分型:A型7例(6.5%),AB型19例(17.6%),B1型23例(21.3%),B2型19例(17.6%),B3型27例(25.0%),C型13例(12.0%).临床分期:Ⅰ期36例(33.3%),Ⅱ期34例(31.5%),Ⅲ期27例(25.0%),Ⅳa期11例(10.2%).临床分期与组织学分型存在显著相关性(P=0.000).A型、AB型、B1型、B2型、B3型胸腺瘤的5年生存率分别为100%、100%、93%、83%、43%;10年生存率分别为100%、100%、81%、70%、33%.C型胸腺瘤中位生存时间62.5个月.B2、B3型胸腺瘤患者的预后介于C型胸腺瘤和A、AB、B1型胸腺瘤之间(P=0.000).临床Ⅰ、Ⅱ、Ⅲ期胸腺肿瘤切除术后5年生存率分别为100%、77%、54%;10年生存率分别为100%、70%、27%.Ⅳa期患者中位生存时间14.0个月.在多因素统计分析中,Masaoka临床分期足胸腺瘤患者最重要的独立预后指标(P=0.000).胸腺肿瘤组织学分型和肿瘤完整切除与否是影响预后的重要决定因素.结论 Masaoka临床分期是影响胸腺瘤患者生存的最重要的预后参数,WHO组织学分型和肿瘤是否完整切除是影响胸腺瘤患者术后生存的决定因素.WHO组织学分型能反映胸腺瘤各亚型的临床生物学行为,A、AB和B1型胸腺瘤为潜在恶性的肿瘤,而B2和B3型胸腺瘤为中度恶性肿瘤,C型胸腺瘤预后差,属于高度恶性肿瘤.

abstractsObjective To study the prognostic and clinical relevance of histologic subtyping ofthymoma according to the World Health Organization (WHO) classification. Methods Theelinicopathologic features of 108 patients with thymoma removed surgically were retrospectively reviewed.The histologic diagnosis of the tumors was made on the basis of 2004 WHO classification by two experiencedpathologists. The correlation between Masaoka tumor stage, WHO histologic subtype, completeness ofresection, presence of myasthenia gravis, other clinical parameters (including age, gender and tumor size)and survival was studied. Results According to WHO classification, there were 7 cases (6. 5%) of type Athymoma, 19 cases (17.6%) of type AB thymoma, 23 cases (21.3%) of type B1 thymoma, 19 cases(17.6%) of type B2 thymoma, 27 cases (25.0%) of type B3 thymoma and 13 cases (12. 0%) of type Cthymoma. According to Masaoka tumor staging, 36 cases (33.3%) were in stage Ⅰ , 34 cases (31.5%)in stage Ⅱ , 27 cases (25. 0%) in stage Ⅲ and 11 cases (10. 2%) in stage Ⅳa. The association betweenhistologic subtype and Masaoka tumor stage was statistically significant (P = 0. 000). The 5-year survivalrates of type A, AB, B1, B2 and B3 thymoma cases were 100%, 100%, 93%, 83% and 43%,respectively; while the 10-year survival rates were 100%, 100%, 81%, 70% and 33%, respectively. Themedian survival time of type C thymoma was 62. 5 months. Type B2 and B3 thymoma cases had anintermediate prognostic ranking in comparison with type C thymoma and other groups (P = 0. 000). The5-year survival rates of tumors in stage Ⅰ ,Ⅱ and Ⅲ were 100%, 77% and 54%, respectively; while the10-year survival rates were 100%, 70% and 27%, respectively. The median survival time of patients in stage Ⅳa was 14. 0 months. Masaoka tumor stage was highly significant in predicting survival of patients(P = 0. 000). On multivariate analysis, Masaoka tumor stage was an independent predictive factor for survival(P =0. 027). On the other hand, the WHO subtype (type A to B1 versus type B2 to B3 versus type C) andcompleteness of resection could predict the tumor-related survival. Conclusions The Masaoka tumor stage isthe single most important prognostic factor of thymoma. The WHO histologic subtype and completeness ofresection affect mainly the post-operative survival. The classification of thymoma may also reflect the clinicalbehavior of the tumor. Type A, AB and B1 thymomas belong to the low-risk group, while type B2 and B3thymomas have an intermediate prognostic ranking. Type C thymoma carries the worst prognosis.