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目的探讨原发性纵隔恶性生殖细胞肿瘤(PMGCT)的临床病理特点、治疗方法和预后因素。方法回顾性分析29例PMGCT患者的临床资料。结果29例患者均为男性,平均发病年龄26.1岁,肿瘤均来源于前纵隔,平均最大径16.0 cm。其中原发性纵隔精原细胞瘤(PMSGCT)5例(17.2%),原发性纵隔非精原细胞瘤(PMNSGCT)24例(82.8%)。PMGCT最常见症状是憋气、咳嗽与胸痛,其治疗采用化疗、手术、放疗相结合的综合治疗模式。PMNSGCT组中化生存期为19.0个月, 1年和2年生存率分别为65.3%和28.1%。PMSGCT组均长期生存,预后优于PMNSGCT组(P= 0.008)。多因素分析结果显示,病变局限于纵隔、以顺铂为基础的联合化疗是PMNSGCT患者预后的独立影响因素。结论PMGCT以PMNSGCT为主,主要治疗手段是以顺铂为基础的联合化疗。PMNSGCT预后明显差于PMSGCT,并与病变范围、化疗与否相关。
Objective To investigate the clinicopathological characteristics, treatment and prognostic factors of primary malignant germ cell tumor of the mediastinum (PMGCT). Methods The clinical data of 29 patients with PMGCT were retrospectively analyzed. Results All 29 patients were male, with an average age of 26.1 years. The tumors originated from the anterior mediastinum with an average diameter of 16.0 cm. There were 5 cases (17.2%) of primary mediastinal seminoma (PMSGCT) and 24 (82.8%) cases of primary mediastinal non-seminoma (PMNSGCT). PMGCT most common symptoms are suffocation, cough and chest pain, the treatment of chemotherapy, surgery, radiotherapy combination of integrated treatment mode. The median survival was 19.0 months in the PMNSGCT group and 65.3% and 28.1% in the 1-year and 2-year groups, respectively. Long-term survival of PMSGCT group was better than that of PMNSGCT group (P = 0.008). Multivariate analysis showed that the lesions were confined to the mediastinum and cisplatin-based combination chemotherapy was an independent prognostic factor in patients with PMNSGCT. Conclusion PMGCT is mainly based on PMNSGCT, and the main treatment is cisplatin-based combination chemotherapy. PMNSGCT prognosis was significantly worse than PMSGCT, and with the extent of the disease, chemotherapy or not.