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背景与目的探讨术前诱导治疗在胸腺瘤中的应用及其对局部进展期胸腺瘤预后的影响。方法收集中国胸腺肿瘤协作组(Chinese Alliance of Research for Thymomas,ChART)1994年1月1日至2012年12月31日回顾性数据库中局部进展期胸腺瘤(Masaoka-Koga分期为Ⅲ期-IVa期)病例。分为诱导治疗组和直接手术组,对比分析两组的R0切除率、5年复发率及5年生存率等指标。诱导治疗组术后分期为Masaoka-Koga Ⅰ期-Ⅱ期的病例视为诱导治疗后降期。为更加精确评估诱导治疗效果,在剔除术后Ⅳ期病例的基础上,再次将诱导治疗组术后Masaoka-Koga Ⅰ期-Ⅲ期的病例与直接手术组Masaoka-Koga Ⅲ期的病例进行对比分析。结果 ChART回顾性数据库1,713例有效病例中,局部进展期胸腺瘤706例,仅68例(4%)作了术前诱导治疗,R0切除率为67.6%,5年复发率为44.9%,5年与10年生存率分别为49.7%和19.9%。其中17例诱导治疗后达到降期,降期亚组中胸腺瘤的比例高于胸腺癌(38.7%vs 13.9%,P=0.02);与未降期亚组相比,降期亚组获得更高的5年生存率(93.8%vs 35.6%,P=0.013)。剔除术后Ⅳ期的病例后,直接手术组和诱导治疗组R0切除率接近(76.4%vs73.3%,P=0.63),但5年生存率差异明显(85.2%vs 68.1%,P<0.001),对于降期亚组,5年生存率优于直接手术组(93.8%vs 85.2%,P=0.438),未降期亚组5年生存率仅35.6%,明显差于降期亚组和直接手术组(P<0.001)。结论术前诱导治疗目前尚未在局部进展期胸腺瘤中广泛应用,但ChART的回顾性数据研究显示通过有效的术前诱导治疗可以使难以彻底切除的病例降期后增加R0切除的机会,从而延长生存,特别是胸腺瘤的病例。这一初步结果将有助于未来的研究。
BACKGROUND & AIM To investigate the application of preoperative induction therapy in thymoma and its effect on the prognosis of locally advanced thymoma. Methods The retrospective data were collected from the Chinese Alliance for Research for Thymomas (ChART) from January 1, 1994 to December 31, 2012 in patients with locally advanced thymoma (Masaoka-Koga stage Ⅲ-IVa ) Cases. Divided into induction therapy group and direct surgery group, comparative analysis of two groups R0 resection rate, 5-year recurrence rate and 5-year survival rate and other indicators. Induction treatment group postoperative staging Masaoka-Koga Ⅰ-Ⅱ phase of the case as the induction of treatment after the decline. In order to evaluate the effect of induction therapy more accurately, the cases of masaoka-koga stage I-III postoperatively in the induction therapy group were again compared with the Masaoka-Koga phase III direct surgery group . Results Among 1,713 valid cases of ChART retrospective database, there were 706 cases of locally advanced thymoma and only 68 cases (4%) were treated with preoperative induction. R0 resection rate was 67.6%, 5-year recurrence rate was 44.9% and 5 years And 10-year survival rates were 49.7% and 19.9%. Among them, 17 cases reached the stage of down-regulation after induction therapy, and the proportion of thymoma in sub-group was higher than that in thymoma (38.7% vs 13.9%, P = 0.02). Compared with non-sub-subgroup, High 5-year survival (93.8% vs 35.6%, P = 0.013). Excluding the postoperative stage Ⅳ, the R0 resection rate was similar in the direct surgery group and the induction therapy group (76.4% vs 73.3%, P = 0.63), but the 5-year survival rate was significantly different (85.2% vs 68.1%, P <0.001) ). The 5-year survival rate was significantly lower in the subsided group than in the direct operation group (93.8% vs 85.2%, P = 0.438). The 5-year survival rate in suboptimal subgroup was 35.6% Direct surgery group (P <0.001). Conclusions Preoperative induction therapy is not yet widely used in locally advanced thymoma. However, the retrospective data from ChART show that patients with difficult to completely resect can be prolonged by decreasing the chance of R0 resection after the expiry of effective early preoperative induction therapy Survival, especially in thymoma cases. This initial result will help future research.