胸腺类癌外科治疗的长期结果_中国胸心血管外科临床杂志

作者：

郭峰 , 张志庸 , 崔玉尚等

中国医学科学院中国协和医科大学北京协和医院胸外科，北京 100730;

关键词：

胸腺类癌肿瘤胸腺瘤外科

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目的探讨胸腺类癌的临床表现，分类与预后的关系，以及手术方式及术后辅助治疗特点，以提高对该病的认识。方法回顾性分析北京协和医院1980年1月至2006年1月18例胸腺类癌的外科治疗和随诊结果。开胸探查活检2例，姑息性切除2例，完整切除14例，包括2例上腔静脉系统切除移植人工血管。采用寿命表法计算生存率，用Cox单因素回归模型分析胸腺类癌预后的影响因素。结果 2例行开胸探查患者分别于术后1年和2年死亡；2例姑息性切除术后患者症状暂时缓解；完整切除患者除1例合并柯兴综合征术后2周死于败血症，其余13例术后完全恢复，随诊5个月至15年良好。全组3年、5年、10年生存率分别为72.6%、60.5%和40.3%。经Cox单因素分析结果：纵隔淋巴结转移(P=0047)、病理类型(P=0000)、手术方式(P=0000)和术后综合治疗(P=0018)是影响预后的因素。结论胸腺类癌不同于胸腺瘤、胸腺癌，临床诊断困难；病理学分典型和不典型胸腺类癌，两者临床表现和预后明显不同。不典型类癌恶性程度高，切除后容易复发和转移，预后较差。彻底切除肿瘤以及受侵的组织和器官，可以明显提高长期生存率。术后放疗、化疗有一定辅助作用。

引用本文： 郭峰,张志庸,崔玉尚等. 胸腺类癌外科治疗的长期结果. 中国胸心血管外科临床杂志, 2007, 14(6): 422-. doi: 复制

1.	Rosai J, Higa E. Mediastinal endocrine neoplasm of probable thymic origin, related to carcinoid tumor. Clinicopathologic study of 8 cases. Cancer, 1972, 29(4):1061-1074.
2.	Detterbeck FC, Parsons AM. Thymic? tumors. Ann Thorac Surg, 2004, 77(5): 1860-1869.
3.	张志庸,郝武森,任华,等. 胸腺类癌(附7例报告). 中华肿瘤杂志, 1992, 14(5): 382-384.
4.	黄进丰,汪良骏,李鉴,等.胸腺类癌4例. 中华胸心血管外科杂志, 1999, 15(6): 363.
5.	朱全,陈广明,朱宁. 胸腺类癌的外科治疗. 中国肿瘤临床与康复, 2001, 8(3): 85-86.
6.	钟华,陈岗,韩宝惠.8例胸腺类癌的临床分析. 肿瘤学杂志, 2002, 8(4): 236-237.
7.	de Perrot M, Spiliopoulos A, Fischer S, et al. Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing’s syndrome. Ann Thorac Surg, 2002, 73(2):675-681.
8.	Filosso PL, Actis Dato GM, Ruffini E, et al. Multidisciplinary treatment of advanced thymic neuroendocrine carcinoma (carcinoid): Report of a successful case and review of the literature. J Thorac Cardiovasc Surg, 2004,127(4): 1215-1219.
9.	Liu HC, Hsu WH, Chen YJ, et al. Primary thymic carcinoma. Ann Thorac Surg,2002,73(4): 1076-1081.??.
10.	Markou A, Manning P, Kaya B, et al. [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography imaging of thymic carcinoid tumor presenting with recurrent Cushing’s syndrome. Eur J Endocrinol, 2005,152(4): 521-525.
11.	Arrigoni MG, Woolner LB, Bernatz PE. Atypical carcinoid tumors of the lung. J Thorac Cardiovasc Surg,1972,64(3): 413-421.
12.	Travis WD, Rush W, Flieder DB, et al. Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical carcinoid and its separation from typical carcinoid. Am J Surg Pathol, 1998, 22(8): 934-944.
13.	Rosai J, Sobin LH. World Health Organization International Histological Classification of Tumors: Histological Typing of Tumors of the Thymus, 2nd ed. Berlin: Springer Verlag, 1999. 15-18.
14.	Gal AA, Kornstein MJ, Cohen C, et al. Neuroendocrine tumors of the thymus: a clinicopathological and prognostic study. Ann Thorac Surg, 2001, 72(4):1179-1182.
15.	Sakuragi T, Rikitake K, Nastuaki M, et al.Complete resection of recurrent thymic carcinoid using cardiopulmonary bypass. Eur J Cardiothorac Surg, 2002, 21(1):152-154.
16.	Chaer R, Massad MG, Evans A, et al. Primary neuroendocrine tumors of the thymus. Ann Thorac Surg, 2002, 74(5):1733-1740.
17.	Tiffet O, Nicholson AG, Ladas G, et al. A clinicopathologic study of 12 neuroendocrine tumors arising in the thymus. Chest, 2003,124(1):141-146.

1. 　Rosai J, Higa E. Mediastinal endocrine neoplasm of probable thymic origin, related to carcinoid tumor. Clinicopathologic study of 8 cases. Cancer, 1972, 29(4):1061-1074.
2. 　Detterbeck FC, Parsons AM. Thymic? tumors. Ann Thorac Surg, 2004, 77(5): 1860-1869.
3. 　张志庸,郝武森,任华,等. 胸腺类癌(附7例报告). 中华肿瘤杂志, 1992, 14(5): 382-384.
4. 　黄进丰,汪良骏,李鉴,等.胸腺类癌4例. 中华胸心血管外科杂志, 1999, 15(6): 363.
5. 　朱全,陈广明,朱宁. 胸腺类癌的外科治疗. 中国肿瘤临床与康复, 2001, 8(3): 85-86.
6. 　钟华,陈岗,韩宝惠.8例胸腺类癌的临床分析. 肿瘤学杂志, 2002, 8(4): 236-237.
7. 　de Perrot M, Spiliopoulos A, Fischer S, et al. Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing’s syndrome. Ann Thorac Surg, 2002, 73(2):675-681.
8. 　Filosso PL, Actis Dato GM, Ruffini E, et al. Multidisciplinary treatment of advanced thymic neuroendocrine carcinoma (carcinoid): Report of a successful case and review of the literature. J Thorac Cardiovasc Surg, 2004,127(4): 1215-1219.
9. 　Liu HC, Hsu WH, Chen YJ, et al. Primary thymic carcinoma. Ann Thorac Surg,2002,73(4): 1076-1081.??.
10. 　Markou A, Manning P, Kaya B, et al. [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography imaging of thymic carcinoid tumor presenting with recurrent Cushing’s syndrome. Eur J Endocrinol, 2005,152(4): 521-525.
11. 　Arrigoni MG, Woolner LB, Bernatz PE. Atypical carcinoid tumors of the lung. J Thorac Cardiovasc Surg,1972,64(3): 413-421.
12. 　Travis WD, Rush W, Flieder DB, et al. Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical carcinoid and its separation from typical carcinoid. Am J Surg Pathol, 1998, 22(8): 934-944.
13. 　Rosai J, Sobin LH. World Health Organization International Histological Classification of Tumors: Histological Typing of Tumors of the Thymus, 2nd ed. Berlin: Springer Verlag, 1999. 15-18.
14. 　Gal AA, Kornstein MJ, Cohen C, et al. Neuroendocrine tumors of the thymus: a clinicopathological and prognostic study. Ann Thorac Surg, 2001, 72(4):1179-1182.
15. 　Sakuragi T, Rikitake K, Nastuaki M, et al.Complete resection of recurrent thymic carcinoid using cardiopulmonary bypass. Eur J Cardiothorac Surg, 2002, 21(1):152-154.
16. 　Chaer R, Massad MG, Evans A, et al. Primary neuroendocrine tumors of the thymus. Ann Thorac Surg, 2002, 74(5):1733-1740.
17. 　Tiffet O, Nicholson AG, Ladas G, et al. A clinicopathologic study of 12 neuroendocrine tumors arising in the thymus. Chest, 2003,124(1):141-146.

中国胸心血管外科临床杂志

胸腺类癌外科治疗的长期结果

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中国胸心血管外科临床杂志

胸腺类癌外科治疗的长期结果

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