单一医生组原发性纵隔肿瘤外科治疗的长期随访

摘要

目的：总结单一医生组原发性纵隔肿瘤外科治疗的长期随访。方法：数据来自北京大学肿瘤医院2000年1月至2014年1月的前瞻性数据库。分析纵隔肿瘤数据库中以根治切除为目的患者的远期生存。结果：本组常见肿瘤依次为胸腺上皮肿瘤95例（50%），神经源性肿瘤26例（13.7%），纵隔生殖细胞肿瘤26例（13.7%）。全组患者行R0切除者179例（94.2%），R2切除者8例（4.2%），单纯探查者3例（1.6%），术后30d内死亡2例。胸腺上皮肿瘤1、3和5年生存率分别为95%、92.7%和85.7%。根据Masaoka-Koga分期，Ⅰ、Ⅱ、Ⅲ和Ⅳ期胸腺上皮肿瘤的5年生存率分别为100%、82.1%、90%和37.5%。多因素分析显示Masaoka-Koga分期是胸腺上皮肿瘤手术后独立预后因素。A+AB+B1型与B2+B3型胸腺瘤5年生存率分别为88.6%与76.9%，差异具有统计学意义（P<0.05）。神经源性纵隔肿瘤多为良性，完整切除后均长期生存。结论：纵隔肿瘤组织学复杂，根据其来源、性质、部位及大小来决定治疗。虽然本组患者生存良好，但单一医生组很难做到前瞻性，大样本研究。因此，对纵隔肿瘤尤其是胸腺上皮肿瘤亟需大样本，多中心合作的前瞻性研究，以找到合理的治疗方式。%Objective:Mediastinal tumors are tumors derived from different organs. Due to its rarity, few clinical consensuses on its diagnosis and treatments have been concluded. This paper aims to summarize the experiences of a single-surgeon team on the surgi-cal treatment of primary medisatinal tumors. Methods:Clinical data were collected from a prospective database between January 2000 and January 2014. The analyses were mainly focused on the long-term survival of 190 cases that underwent radical resectioning surger-ies. Results:The three most common mediastinal tumors are thymic epithelial tumors in 95 cases (50%), neurogenic tumors in 26 cases (13.7%), and mediastinal germ cell tumors in 26 cases (13.7%). Of the 190 patients, 179 patients achieved the R0 resection criterion (94.2%), 8 underwent R2 resectioning (4.2%) and 3 underwent only exploration (1.6%), with 2 cases of death in the 30 days after the surgery. The 1-, 3-, and 5-year survival rates of the thymic epithelial tumor patients were 95%, 92.7%, and 85.7%, respectively. Accord-ing to the Masaoka-Koga staging, the 5-year survival rates of stageⅠ,Ⅱ,Ⅲ, andⅣthymic epithelial tumors are 100%, 82.1%, 90%, and 37.5%, respectively. A multivariate analysis reveals that the Masaoka-Koga staging of thymic epithelial tumors is an independent prognostic factor (P<0.05). According to pathological classification, the 5-year survival rates for A+AB+B1 versus B2+B3 type thymo-ma were 88.6%versus 76.9%, which is statistically significant (P<0.05). Most of the neurogenic tumors are benign, all suffer R0 resec-tioning, and have long term survival. Conclusion:Due to the complexity caused by its histology, the treatment of mediastinal tumors should be based on the origin, nature, location, and size of the tumors. Although the patients of the group have a favorable prognosis, it is difficult to draw conclusions from the studies because of its retrospective characteristics and small sample size. Therefore, to get bet-ter clinical evidence, a multi-center, large sample, and prospective clinical study should be performed.