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背景与目的探讨术前病理学诊断在胸腺肿瘤诊断和治疗中的价值及其对胸腺肿瘤治疗的影响。方法对中国胸腺肿瘤协作组(Chinese Alliance for Research in Thymomas,ChART)收集的1994年-2012年的多中心且具有明确活检状态的胸腺肿瘤患者的临床病理资料进行回顾性分析,探讨术前病理学诊断的应用趋势及其对胸腺肿瘤患者预后的影响。结果 1,902例胸腺肿瘤患者中,术前病理学诊断患者336例(17.1%)。近年来术前病理学诊断的比例较前明显增加(P=0.008),胸腔镜/纵隔镜/超声内镜下经支气管活检(endobronchial ultrasound,E-BUS)比例较前升高(P=0.029)。术前行病理学诊断患者的生存明显差于无病理学诊断患者(P<0.001),术前病理学诊断后的目的与肿瘤的Masaoka分期(P<0.001)、切除程度(P=0.025)、病理类型(P<0.001)具有相关性。术前病理学诊断后直接手术患者的生存要明显优于诱导治疗后再手术患者(P<0.001)。结论胸腺瘤诊断主要依靠临床及组织学判断,近年来术前病理学诊断在胸腺肿瘤的诊断和治疗中起重要作用;根治性手术切除是胸腺肿瘤的首先治疗手段;术前病理学诊断后直接手术患者的预后要明显优于诱导治疗后患者。
BACKGROUND & AIM: To investigate the value of preoperative pathological diagnosis in the diagnosis and treatment of thymus tumors and its impact on the treatment of thymus tumors. Methods A retrospective analysis was performed on the clinicopathological data collected from the Chinese Alliance for Research in Thymomas (ChART) from 1994 to 2012 in patients with thyroid tumors with a clear biopsy and biopsy status. The preoperative pathology Diagnostic trends and their impact on the prognosis of patients with thymic tumors. Results Among 1,902 thymoma patients, 336 patients (17.1%) were diagnosed preoperatively. The proportion of preoperative pathological diagnosis increased significantly in recent years (P = 0.008). The proportion of endobronchial ultrasound (E-BUS) under thoracoscopic / mediastinoscopy / endoscopic ultrasonography was significantly higher than before (P = 0.029) . The preoperative pathological diagnosis showed significantly worse survival than those without pathological diagnosis (P <0.001). The purpose of preoperative pathological diagnosis was related to Masaoka stage (P <0.001), degree of resection (P = 0.025) Pathological types (P <0.001) were correlated. The survival of patients undergoing direct surgery after preoperative pathological diagnosis was significantly better than that after reoperation after induction therapy (P <0.001). Conclusion The diagnosis of thymoma depends mainly on the clinical and histological judgment. In recent years, preoperative pathological diagnosis plays an important role in the diagnosis and treatment of thymus tumors. Radical surgical resection is the first treatment of thymus tumors. The preoperative pathological diagnosis is direct The prognosis of surgery patients should be significantly better than after induction therapy in patients.