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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: To summarize the long-term follow-up of surgical treatment of primary mediastinal tumors in a single physician group. METHODS: Data were from a prospective database from Peking University Cancer Hospital from January 2000 to January 2014. To analyze the long-term survival of patients with radical resection in the mediastinal tumor database. Results: The common tumors were thymic epithelial tumor in 95 cases (50%), neurogenic tumor in 26 cases (13.7%) and mediastinal germ cell tumor in 26 cases (13.7%). All patients underwent R0 resection in 179 cases (94.2%), R2 resection in 8 cases (4.2%), simple exploration in 3 cases (1.6%) and postoperative death in 2 cases. The 1, 3 and 5-year survival rates of thymic epithelial tumors were 95%, 92.7% and 85.7%, respectively. According to the Masaoka-Koga staging, the 5-year survival rates for stage I, II, III and IV thymic epithelial tumors were 100%, 82.1%, 90% and 37.5%, respectively. Multivariate analysis showed that the Masaoka-Koga staging was an independent prognostic factor for thymic epithelial tumor surgery. The 5-year survival rates of A + AB + B1 type and B2 + B3 type thymoma were 88.6% and 76.9%, respectively, with statistical significance (P <0.05). Neurogenic mediastinal tumors are mostly benign, after a complete resection are long-term survival. Conclusion: Mediastinal tumor histology is complex, according to its origin, nature, location and size to decide treatment. Although this group of patients survived well, it was difficult for a single physician group to do prospective, large sample studies. Therefore, the mediastinal tumors, especially thymic epithelial tumors in urgent need of large sample, multi-center prospective study to find a reasonable treatment.