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背景与目的胸腔镜胸腺切除术相比开放手术治疗早期(Masaoka-Koga Ⅰ期或Ⅱ期)胸腺恶性肿瘤在理论上具有优势,然而尚未有研究报道其在长期生存率方面的差异。本研究基于中国胸腺肿瘤研究协作组(Chinese Alliance for Research in Thymomas,ChART)的数据库对此进行了研究。方法以数据库中1994年到2012年间的1,117例早期(Masaoka-Koga Ⅰ期或Ⅱ期)胸腺恶性肿瘤患者为研究对象。其中241例行胸腔镜胸腺切除术,876例行开放手术。采用单因素分析比较两组的临床资料与围手术期结果方面的差异。采用多因素分析明确影响长期预后的相关因素。结果与开放手术组相比,胸腔镜组的全胸腺切除比例更高(80.5%vs73.9%,P=0.028),根治性切除率更高(98.8%vs 88.7%,P<0.000),而复发率更低(2.9%vs 16.0%,P<0.001),5年无瘤生存率更高(92%vs 83%,P=0.011),而两组的5年生存率接近(92%vs 92%,P=0.15)。Cox比例风险模型分析显示WHO分型、Masaoka-Koga分期和术后辅助治疗是影响胸腺恶性肿瘤长期生存的独立因素。结论胸腔镜胸腺切除术是治疗早期胸腺恶性肿瘤安全有效的方法,与开放手术相比其围手术期效果更好,肿瘤学疗效一致。
Background and Objective Thoracoscopic thymectomy has the theoretical advantage in the early stage of thoracic malignancy (Masaoka-Koga stage I or II) compared with open surgery. However, no studies have reported any differences in long-term survival. This study was based on the database of the Chinese Alliance for Research in Thymomas (ChART). Methods A total of 1,117 early-stage (Masaoka-Koga Stage I or II) thymoma patients from 1994 to 2012 in the database were studied. Among them, 241 cases underwent thoracoscopic thymectomy and 876 underwent open surgery. Univariate analysis was used to compare differences in clinical data and perioperative outcomes between the two groups. Using multivariate analysis to clearly influence long-term prognosis related factors. Results Compared with the open surgery group, the total thymectomy rate was higher in the thoracoscopic group (80.5% vs 73.9%, P = 0.028), and the radical resection rate was higher (98.8% vs 88.7%, P <0.000) The 5-year disease-free survival rate was higher (92% vs 83%, P = 0.011), while the 5-year survival rate was similar in both groups (92% vs 92.0% %, P = 0.15). Cox proportional hazards model analysis showed that the WHO classification, Masaoka-Koga staging and postoperative adjuvant therapy are independent factors affecting the long-term survival of thymus malignant tumors. Conclusions Thoracoscopic thymectomy is a safe and effective method for the treatment of early thymus malignant tumors. Compared with open surgery, thoracic thymectomy is more effective in perioperative period and has the same efficacy in oncology.