| Objuctive:Thymic tumor could originate from a variety of tissues. Thymic carcinoma drived from epithelial cells of thymus, with low incidence, is a rare mediastinal malignant tumor. But its incidence increases in recent years. Thymic carcinoma is similar to other thymic tumors in aspects of tumor location, radiological characteristics and clinic symptoms, but histologic behavior of thymic carcinoma is significantly different from the other thymic tumors, which shows highly aggressive malignancy. The diagnosis and treatment of thymic carcinoma are different from other thymic tumors. There is still a lot of controversy in the mode and efficacy of treatment because of limited clinic experience. This paper analyzes the clinical features of thymic carcinoma and further researches the prognostic factors to improve the level of the diagnosis and treatment of thymic carcinoma.Methods:We analyzed the clinical data of29patients with thymic carcinoma from February2003to February2012in our hospital thoracic surgery and further follow-up.Result:Among the total29patients, there were19males (mean age49.8±7.2years) and10females (mean age45.8±10.2years), with a median age of48years old. All patients accepted the surgical treatment.19patients underwent complete resection including tumor and surrounding tissues. The incomplete resection was performed in6patients.3patients were treated with the thorascopic biopsy, and1patient was treated with the exploratory thoracotomy and biopsy alone. All tumors were founded have no complete capsule and invaded surrounding tissues or organs, including the superior vena cava and left or right innominate vein (13cases), pleura (13cases), pericardium (11cases), lung (9cases), ascending aorta and pulmonary artery (3cases), and trachea or bronchus (1cases). There was no operative mortality and the postoperative patients recovered well. Some patients were treated with radiotherapy and chemotherapy after surgery. All patients were confirmed as thymic carcinoma by postoperative pathological examination, including10cases of the thymic squamous cell carcinoma,5cases of mucoepidermoid carcinoma,3cases of basaloid carcinoma,5cases of carcinoid carcinoma,2cases of lymphoepithelioma-like carcinoma,2cases of undifferentiated carcinoma,1cases of sarcomatoid carcinoma,1cases of clear cell carcinoma. Masaoka’s system was used for staging(stage II,3cases; stagelll,20cases; stage IVa,5cases; stage Ⅳb,1cases). Through one to ten years follow-up, clinic data was successfully obtained from25patients (86.21%,25/29), and others were lost to follow-up.5patients died in1year after operation.3patients died within the second year after surgery, the number of death within3rd,5th and8th years after surgery is3,2and1cases, respectively.1,2,3,5and10-year survival rate is80.00%,68.00%,56.00%,32.00%and16.00%, respectively, with an average survival time of40.5months. The four cases are still alive at the end of this study. The Kaplain-Meier method and Log Rank (Mantel-Cox) method were used to analysis of the prognostic factors of the thymic carcinoma by SPSS statistical software.Conclusions:Thymic carcinoma should be identified from other thymic tumors and tumor-like lesions in terms of clinical manifestations, imaging features, pathological types and prognostic characteristic. Thymic carcinoma is a highly malignant tumor in the mediastinum, prone to invasing surrounding tissues, with the poor prognosis.5-year survival rate is only32.00%. The treatment model of thymic carcinoma should follow the principle of staging treatment. Surgery should be considered as first choice for treatment of I,11stage of thymic carcinoma. Patients of Ⅲ, Ⅳa stage are adopted different treatment according to whether completely surgical resection and adjuvant therapy including chemotherapy and radiotherapy should be performed according to pathological Masaoka’s system, the ZPS score and whether residual carcinoma. Patients of IVb stage of thymic carcinoma are treated by systemic chemotherapy. Comprehensive therapy oriented to surgery is main treatment of thymic carcinoma, with relative effective results. The complete resection of thymic carcinoma and the invasing tissues and organs, even the superior vena cava, can significantly improves long-term survival rate. The chemotherapeutic regimens based on platinum drugs play a significant role in improvement of therapeutic effects, such as cisplatin. Local radiotherapy should be given after surgery, if necessary, including prevention and treatment of complications. Completely surgical resection, Masaoka staging, WHO histological type, great vessels invasion and age are main factors of the prognosis of thymic carcinoma. |
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