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背景与目的探讨术后化疗在胸腺肿瘤中的应用及术后化疗对Masaoka Ⅲ期/Ⅳ期预后的影响。方法 1994年3月至2012年12月,中国胸腺瘤研究协作组(Chinese Alliance of Research for Thymomas,ChA RT)数据库共纳入2,306例胸腺肿瘤病例,资料相对完整1,700例患者纳入本研究,对其中Masaoka Ⅲ期/Ⅳ期665例患者进行进一步分析,初步评估术后化疗的临床价值,采用Kaplan-Meier法绘制不同亚组患者生存曲线,Cox回归进行多因素分析影响预后的因素。采用倾向值匹配研究(propensity-matched study,PSM),评估化疗的临床价值。结果 1,700例患者中未行术后化疗1,406例(82.7%),术后化疗294例(17.3%),随着Masaoka分期的增加,术后化疗患者的比例也随之增高,差异有统计学意义(P<0.001)。对Masaoka Ⅲ期/Ⅳ期患者665例进行进一步分析,其中未术后化疗组444例,术后化疗组221例。两组患者在有无重症肌无力、WHO病理类型、病理分期、手术根治性、有无术后放疗等方面分布有差异(P<0.05)。其中C型胸腺瘤、不完全切除和术后放疗明显影响患者术后复发和生存(P<0.05)。术后化疗组5年和10年无病生存率分别为51%、30%,5年和10年复发率分别为46%、68%,而未术后化疗组5年和10年无病生存率分别为73%、58%。5年和10年复发率分别为26%、40%,两组无病生存率和复发率均有明显统计学差异(P=0.001,P=0.001)。对有无重症肌无力,病理类型,病理分期,手术根治性状态,术后放疗等因素进行倾向值匹配筛选出其中158例未术后化疗和158例术后化疗共316例患者,生存分析显示:未术后化疗组和术后化疗组两组5年生存率并无明显统计学差异(P=0.332)。结论病理学类型、手术的根治性和术后放疗是影响进展期胸腺肿瘤患者术后生存和复发的主要因素。术后化疗并未给Masaoka-Koga Ⅲ期/Ⅳ期胸腺瘤患者带来生存获益。
BACKGROUND & AIM To investigate the application of postoperative chemotherapy in thymus tumor and the effect of postoperative chemotherapy on the prognosis of Masaoka stage Ⅲ / Ⅳ. Methods From March 1994 to December 2012, a total of 2,306 cases of thymoma were enrolled in the Chinese Alliance for Research Thymomas (ChA RT) database. The data were relatively complete and 1,700 patients were included in this study. Among them, Masaoka 665 patients in stage Ⅲ / Ⅳ were further analyzed to evaluate the clinical value of postoperative chemotherapy. Survival curves of patients in different subgroups were drawn by Kaplan-Meier method, and prognostic factors were analyzed by Cox regression. The propensity-matched study (PSM) was used to assess the clinical value of chemotherapy. Results Among the 1,700 patients, 1,406 (82.7%) patients did not receive postoperative chemotherapy and 294 (17.3%) patients received postoperative chemotherapy. The proportion of patients receiving postoperative chemotherapy increased with the increase of Masaoka stage, with a statistically significant difference (P <0.001). 665 cases of Masaoka stage III / IV patients were further analyzed, including 444 cases without postoperative chemotherapy and 221 cases with postoperative chemotherapy. The two groups of patients with or without myasthenia gravis, WHO pathological type, pathological staging, radical surgery, with or without postoperative radiotherapy distribution differences (P <0.05). Among them, C-type thymoma, incomplete resection and postoperative radiotherapy significantly affected the recurrence and survival of patients (P <0.05). The 5-year and 10-year disease-free survival rates of postoperative chemotherapy were 51%, 30%, 5 years and 10 years respectively, and the recurrence rates were 46% and 68% respectively Rates were 73%, 58%. The 5-year and 10-year recurrence rates were 26% and 40% respectively. There was a significant difference between the two groups in disease-free survival and recurrence (P = 0.001, P = 0.001). A total of 316 patients with 158 patients who did not receive postoperative chemotherapy and 158 patients who received postoperative chemotherapy were selected for propensity matching with and without myasthenia gravis, pathological type, pathological staging, radical operation status and postoperative radiotherapy. Survival analysis showed that There was no significant difference in 5-year survival rate between the two groups before and after chemotherapy (P = 0.332). Conclusions The pathological type, radical operation and postoperative radiotherapy are the main factors affecting the survival and recurrence of patients with advanced thymoma. Postoperative chemotherapy did not benefit survival in patients with Masaoka-Koga stage III / IV thymoma.